Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 0101049336 | VA |
NPI | 1043312648 |
---|---|
Provider Name | Jacob N Young |
First Address | Baltimore, MD 21279-0777 |
Second Address | Charlottesville, VA 22911-4668 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 13/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G44844 | (02) |