Provider Demographics
NPI:1053311449
Name:YOUNGDAHL, PAULA S (MD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:S
Last Name:YOUNGDAHL
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 1:2580 CONSTITUTION BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-1294
Mailing Address - Country:US
Mailing Address - Phone:724-843-0737
Mailing Address - Fax:724-843-0833
Practice Address - Street 1:2580 CONSTITUTION BLVD
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-1294
Practice Address - Country:US
Practice Address - Phone:724-843-0737
Practice Address - Fax:724-843-0833
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036251E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1171970Medicaid
PA179325LCNMedicare PIN
PA1171970Medicaid