Provider Demographics
NPI: | 1003834284 |
---|---|
Name: | YOUNG, HAZEL G (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | HAZEL |
Middle Name: | G |
Last Name: | YOUNG |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 20800 HARVARD RD |
Mailing Address - Street 2: | 2ND FLOOR |
Mailing Address - City: | HIGHLAND HILLS |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 44122-7251 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 11100 EUCLID AVE |
Practice Address - Street 2: | |
Practice Address - City: | CLEVELAND |
Practice Address - State: | OH |
Practice Address - Zip Code: | 44106-1716 |
Practice Address - Country: | US |
Practice Address - Phone: | 216-844-1700 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-07-17 |
Last Update Date: | 2015-12-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 35-045806 | 2085R0202X, 2085B0100X, 2085D0003X, 2085U0001X, 2085H0002X, 2085N0700X, 2085N0904X, 2085P0229X, 2085R0001X, 2085R0203X, 2085R0204X, 207U00000X, 207UN0903X, 207UN0901X, 207UN0902X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No | 2085B0100X | Allopathic & Osteopathic Physicians | Radiology | Body Imaging |
No | 2085D0003X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Neuroimaging |
No | 2085U0001X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound |
No | 2085H0002X | Allopathic & Osteopathic Physicians | Radiology | Hospice and Palliative Medicine |
No | 2085N0700X | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology |
No | 2085N0904X | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology |
No | 2085P0229X | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology |
No | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No | 2085R0203X | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology |
No | 2085R0204X | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
No | 207U00000X | Allopathic & Osteopathic Physicians | Nuclear Medicine | |
No | 207UN0903X | Allopathic & Osteopathic Physicians | Nuclear Medicine | In Vivo & In Vitro Nuclear Medicine |
No | 207UN0901X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology |
No | 207UN0902X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Imaging & Therapy |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 0750754 | Medicaid | |
OH | 4392807 | Other | AETNA |
OH | 000000216674 | Other | UNISON |
OH | 0304914 | Other | BCMH |
PA | 1024622860001 | Medicaid | |
OH | 745764 | Other | BUCKEYE |
OH | 000000503584 | Other | ANTHEM |
OH | 364160 | Other | WELLCARE |
OH | P00364296 | Other | RAILROAD MEDICARE |
OH | P00364296 | Other | RAILROAD MEDICARE |
OH | YO0636295 | Medicare PIN | |
E29593 | Medicare UPIN |