Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 01043811A | IN |
N | 2080A0000X | Adolescent Medicine | ME97278 | FL |
NPI | 1174545495 |
---|---|
Provider Name | Dr. Mary Helen Lu Young |
First Address | Orlando, FL 32807-3575 |
Second Address | Orlando, FL 32807-3575 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 30/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200159950 | (05) | IN |
277141100 | (05) | FL |
G22790 | (02) |