Provider Demographics
NPI:1073668935
Name:YOUNG, TERENCE H (MD)
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:H
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 1:1875 LIBERTY ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301
Mailing Address - Country:US
Mailing Address - Phone:503-371-1558
Mailing Address - Fax:503-375-3866
Practice Address - Street 1:1875 LIBERTY ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:503-371-1558
Practice Address - Fax:503-375-3866
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD11603208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC94141000001OtherPROVIDENCE INS
OR000172000OtherREGENCE BLUE CROSS INS
OROR2204OtherHEALTH NET INS
ORP00209118OtherRAILROAD MEDICARE
ORR0000BHNBJMedicare PIN