Healthcare Provider Details

I. General information

NPI: 1619909462
Provider Name (Legal Business Name): CRAIG D YINGLING ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MONITOR CT
SALISBURY MD
21801-3667
US

IV. Provider business mailing address

1000 MONITOR CT
SALISBURY MD
21801-3667
US

V. Phone/Fax

Practice location:
  • Phone: 410-546-0230
  • Fax: 410-546-4140
Mailing address:
  • Phone: 410-546-0230
  • Fax: 410-546-4140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: