Provider Demographics
NPI:1073513404
Name:YOUNG, STEPHEN P (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W GRAND AVE
Mailing Address - Street 2:STE. 1003
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-4775
Mailing Address - Country:US
Mailing Address - Phone:937-226-7898
Mailing Address - Fax:937-461-6038
Practice Address - Street 1:425 W GRAND AVE
Practice Address - Street 2:STE. 1003
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-4775
Practice Address - Country:US
Practice Address - Phone:937-226-7898
Practice Address - Fax:937-461-6038
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002825207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0427738Medicaid
OHP00171437OtherRAILROAD MEDICARE
OH0427738Medicaid
OH0841316Medicare PIN
OH0841317Medicare PIN