Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | 0101050317 | VA |
Y | 207VG0400X | Gynecologist | 0101-050317 | VA |
NPI | 1053392399 |
---|---|
Provider Name | Dr. Robert J Young |
First Address | Christiansburg, VA 24073-7026 |
Second Address | Blacksburg, VA 24060-7015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2005 |
Last Update Date | 20/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010166845 | (05) | VA |
A91764 | (02) | VA |