The southern end of the A19 starts at the St Mary's Roundabout with the A630 and A638 just to the north of Doncaster itself near to the parish church.

The A19 heads towards Riccall, following what was the East Coast Main Line before the Selby Diversion was built.

Heading northward, the section between York and Thirsk was not helped much by the opening of the £5 million 3-mile (5 km) Easingwold Bypass in November 1994, as the road remained single carriageway, starting at a roundabout.

North of Thirsk, the A19 takes over from the A168 as the link from the A1 to Teesside and becomes a fast dual carriageway with mostly grade separated interchanges.

The five-mile £4.4 million Thirsk bypass was opened on 5 September 1972 by Robin Turton, Baron Tranmire, the local MP (from 1929), with a flypast by four Royal Air Force Vickers Varsity aircraft – RAF Topcliffe is to the south-west of Thirsk.

It climbs slightly past the junction at Knayton near Borrowby and skirting the western edge of the North York Moors, meeting the A684 (for Northallerton) at Clack Lane End after passing through Leake and by the Haynes Arms.

About 2 miles (3.2 km) from the Parkway Turn (A174) in Middlesbrough the road is raised slightly, overlooking Thornaby industrial estate and the town of Ingleby Barwick, giving clues that Teesside is imminent.

There is a right turn for Dalton Piercy at the Windmill Motel, and two link roads into Elwick, to the east.

It crosses a former railway (now NCN 1 and 14), and meets the A181 (for Wheatley Hill and Durham), and the B1281 (for Hesleden) at an intersection, and passes west of Shotton, where it joins the former route.

The eight miles of sections from Easington to Seaham were built by A. R. Carmichael in late 1971, and made the A19 from Thirsk to Sunderland completely dual-carriageway, with the contract awarded in October 1969.

The 8.75-mile Sunderland Bypass opened as the A108, and was built by W.C. French, with fourteen bridges and five underpasses, with the contract awarded in February 1970.

At Testo's Roundabout with the A184 (for Gateshead and The Boldons), the A19 originally ended as the A1 took over to run through the Tyne Tunnel, before that classification became assigned to the Newcastle Western Bypass from the Angel of the North to Kingston Park.

There is a limited access junction (from the north) for Hedworth, and the road is crossed by the Green Line of the Tyne and Wear Metro.

At the Jarrow Interchange, there is a roundabout for the A185 (for Hebburn) and the B1297 at the start of the single-carriageway £13 million Tyne Tunnel, opened in October 1967 as the A108.

The fire burned for eight hours and led to residents being warned by Cleveland Police of potentially toxic fumes.

In a now famous interview, then local councillor Mr Davidson appeared on TV to declare the road safe.

[6] In June 2008 a fuel tanker began leaking oil from its engine covering a mile-long stretch, including a bend, before stopping near Hartlepool.