Provider Demographics
NPI:1013010313
Name:YOUNG, MARK E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 4TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-1100
Mailing Address - Country:US
Mailing Address - Phone:937-492-7797
Mailing Address - Fax:937-710-9040
Practice Address - Street 1:430 4TH AVE STE 3
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-1100
Practice Address - Country:US
Practice Address - Phone:937-492-7797
Practice Address - Fax:937-710-9040
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3583349207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2435930Medicaid
000000305508OtherANTHEM BCBS
OH2435930Medicaid
H22110Medicare UPIN