Provider Demographics
NPI:1043229768
Name:YOUNG, PETER C (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:C
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 1:1250 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4339
Mailing Address - Country:US
Mailing Address - Phone:617-774-0820
Mailing Address - Fax:617-774-0832
Practice Address - Street 1:1250 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4339
Practice Address - Country:US
Practice Address - Phone:617-774-0820
Practice Address - Fax:617-774-0832
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208685207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA208685OtherTUFTS HEALTH PLAN
MAJ23050OtherBLUE CROSS
MA0027527OtherNEIGHBORHOOD HEALTH PLAN
MA0185621Medicaid
MA2403883-003OtherCIGNA
MA400968OtherHARVARD PILGRIM
MAP00278138OtherMEDICARE RAILROAD
MAH26376Medicare UPIN
MA0185621Medicaid