Provider Demographics
NPI:1801909395
Name:YELLIG, EDWARD BOOTH (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:BOOTH
Last Name:YELLIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 SAINT MARYS ST
Mailing Address - Street 2:FOUTH FLOOR
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1276
Mailing Address - Country:US
Mailing Address - Phone:919-828-0890
Mailing Address - Fax:
Practice Address - Street 1:1300 SAINT MARYS ST
Practice Address - Street 2:FOUTH FLOOR
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1276
Practice Address - Country:US
Practice Address - Phone:919-828-0890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC21619207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC21619OtherSTATE MEDICAL LICENSE
NCAY7635292OtherUS DEA REGISTRATION
NCC87317Medicare UPIN
NC211750SMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER