Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 0104555714 | VA |
N | 111N00000X | Chiropractor | 01979 | MD |
N | 111NN0400X | Neurology | 0104555714 | VA |
N | 111NN0400X | Neurology | 01979 | MD |
N | 111NR0400X | Rehabilitation Chiropractor | 0104555714 | VA |
Y | 111NR0400X | Rehabilitation Chiropractor | 01979 | MD |
N | 111NS0005X | Chiropractic Sports Physician | 0104555714 | VA |
N | 111NS0005X | Chiropractic Sports Physician | 01979 | MD |
N | 111NX0100X | Occupational Health | 0104555714 | VA |
N | 111NX0100X | Occupational Health | 01979 | MD |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 0104555714 | VA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 01979 | MD |
NPI | 1043421563 |
---|---|
Provider Name | Dr. Mariella M Young |
First Address | Rockville, MD 20852-3901 |
Second Address | Rockville, MD 20852-3901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2007 |
Last Update Date | 03/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10419449 | CAQH (01) | MD |
478024 | MAMSI (01) | MD |
617767 | UNITED HEALTHCARE (01) | MD |
F759-0001 | BCBS (01) | DC |
M655-0001 | BCBS (01) | MD |
U79167 | (02) | MD |