1720048267 NPI number — LAURA M YOUNG MD

Table of content: LAURA M YOUNG MD (NPI 1720048267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720048267 NPI number — LAURA M YOUNG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
LAURA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1720048267
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2527 CRANBERRY HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAREHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02571-1046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-841-3500
Provider Business Mailing Address Fax Number:
508-273-1241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2825 PARKLAWN DR
Provider Second Line Business Practice Location Address:
RADIOLOGY DEPT.
Provider Business Practice Location Address City Name:
MIDWEST CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73110-4201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-610-8398
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2006

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: 2085R0202X , with the licence number:  21252 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11845754 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 050885071 . This is a "BC/BS" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 200012950A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".