Provider Demographics
NPI:1043421563
Name:YOUNG, MARIELLA M (DC)
Entity Type:Individual
Prefix:DR
First Name:MARIELLA
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6137 EXECUTIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3901
Mailing Address - Country:US
Mailing Address - Phone:301-770-9601
Mailing Address - Fax:301-770-9540
Practice Address - Street 1:6137 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3901
Practice Address - Country:US
Practice Address - Phone:301-770-9601
Practice Address - Fax:301-770-9540
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01979111N00000X, 111NN0400X, 111NR0400X, 111NS0005X, 111NX0100X, 111NX0800X
VA0104555714111N00000X, 111NN0400X, 111NR0400X, 111NS0005X, 111NX0100X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111N00000XChiropractic ProvidersChiropractor
No111NN0400XChiropractic ProvidersChiropractorNeurology
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD10419449OtherCAQH
DCF759-0001OtherBCBS
MD617767OtherUNITED HEALTHCARE
MDM655-0001OtherBCBS
MD478024OtherMAMSI
DCF759-0001OtherBCBS
DC00A979Y66Medicare PIN
MD617767OtherUNITED HEALTHCARE
MD478024OtherMAMSI
MDU79167Medicare UPIN