Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | D42086 | MD |
NPI | 1003927989 |
---|---|
Provider Name | Mark Allen Young |
First Address | White Marsh, MD 21162-5504 |
Second Address | White Marsh, MD 21162-5500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 02/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
494Q | (02) | MD |