1093043515 NPI number — MR. CLIFFORD ARMANDO YOUNG LADC

Table of content: MR. CLIFFORD ARMANDO YOUNG LADC (NPI 1093043515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093043515 NPI number — MR. CLIFFORD ARMANDO YOUNG LADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
CLIFFORD
Provider Middle Name:
ARMANDO
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LADC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093043515
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 807
Provider Second Line Business Mailing Address:
1 FERNALD POINT ROAD
Provider Business Mailing Address City Name:
SOUTHWEST HARBOR
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04679-0807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-244-4012
Provider Business Mailing Address Fax Number:
207-244-4013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 FERNALD POINT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHWEST HARBOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04679-4614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-244-4012
Provider Business Practice Location Address Fax Number:
207-244-4013
Provider Enumeration Date:
11/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  LC1867 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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