1235120577 NPI number — DR. DAVID Z YOUNG MD

Table of content: DR. DAVID Z YOUNG MD (NPI 1235120577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235120577 NPI number — DR. DAVID Z YOUNG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
DAVID
Provider Middle Name:
Z
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1235120577
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
99 LINCOLN ST
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
FRAMINGHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01702-6327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-875-4811
Provider Business Mailing Address Fax Number:
508-739-0141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99 LINCOLN ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
FRAMINGHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01702-6327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-875-4811
Provider Business Practice Location Address Fax Number:
508-739-0141
Provider Enumeration Date:
11/04/2005

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: 207RC0000X , with the licence number:  47513 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0200X , with the licence number: 47513 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 060067738 . This is a "PALMETTO GBA (RR MCARE)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 84783 . This is a "AETNA/USHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3016081 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7793 . This is a "FALLON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2500284 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0018352 . This is a "NHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3205 . This is a "HPHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 708866 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0161098 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: J05193 . This is a "BCBSMA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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