Individual
RAYMOND A. YEDLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
17TH & CHEW STREET, ALLENTOWN, PA 18102
(610) 402-9099
(610) 402-9029
Mailing address
1245 S CEDAR CREST BLVD, SUITE #301, ALLENTOWN, PA 18103-6258
(610) 402-9099
(610) 402-9029
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN269524L
PA
367500000X
Certified Registered Nurse Anesthetist
Primary
040438
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03226201
CAPITAL ADVANTAGE
PA
05
—
1027812230001
—
PA
01
—
11783713
CAQH
PA
01
—
1345054
HIGHMARK
PA
01
—
1585282
GATEWAY
PA
01
—
2037613000
INDEP. BLUE CROSS
PA
01
—
72366
GEISINGER
PA
01
—
9358458
AETNA
PA
Enumeration date
10/04/2005
Last updated
03/25/2013
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