Basic Information
| Provider Information | |||||||||
| NPI: | 1336706571 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YERGER | ||||||||
| FirstName: | ETHAN | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1681 CHOPTANK RD | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197099043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3028939845 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 E VINE ST | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218045531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4433586445 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2019 | ||||||||
| LastUpdateDate: | 05/23/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DX4709 | MD | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.