Provider Demographics
NPI:1184613317
Name:YINGLING, DOUGLAS B (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:B
Last Name:YINGLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 TURNPIKE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-3028
Mailing Address - Country:US
Mailing Address - Phone:814-765-7314
Mailing Address - Fax:814-339-6165
Practice Address - Street 1:1212 TURNPIKE AVE
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-3028
Practice Address - Country:US
Practice Address - Phone:814-765-7314
Practice Address - Fax:814-339-6165
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028655E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010053060001Medicaid
PA0010053060001Medicaid
PA050723Medicare PIN