Provider Demographics
NPI:1871509067
Name:YOUNGBLOOD, DORIAN J (CRNA)
Entity Type:Individual
Prefix:
First Name:DORIAN
Middle Name:J
Last Name:YOUNGBLOOD
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TRENTON ROAD
Mailing Address - Street 2:DEBORAH HEART AND LUNG CENTER
Mailing Address - City:BROWNS MILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:08048
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 TRENTON ROAD
Practice Address - Street 2:DEBORAH HEART AND LUNG CENTER
Practice Address - City:BROWNS MILLS
Practice Address - State:NJ
Practice Address - Zip Code:08048
Practice Address - Country:US
Practice Address - Phone:609-893-6611
Practice Address - Fax:609-735-0415
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ11837200367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ088355Medicare PIN
NJ088355AQEMedicare PIN