Provider Demographics
NPI:1336202175
Name:YOUNGER, ERNEST D (MDMPH)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:D
Last Name:YOUNGER
Suffix:
Gender:M
Credentials:MDMPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 E CASWELL ST
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-5309
Mailing Address - Country:US
Mailing Address - Phone:252-527-2643
Mailing Address - Fax:
Practice Address - Street 1:500 BEAMAN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2602
Practice Address - Country:US
Practice Address - Phone:910-289-9248
Practice Address - Fax:910-289-7437
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21385174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist