Provider Demographics
NPI:1114036027
Name:YOUNG, ROGER CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:CHARLES
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 1:262 MEADOWGROVE LN
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2611
Mailing Address - Country:US
Mailing Address - Phone:802-658-4959
Mailing Address - Fax:
Practice Address - Street 1:853 JEFFERSON AVE
Practice Address - Street 2:E160
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2807
Practice Address - Country:US
Practice Address - Phone:901-448-1509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420011205207V00000X
TN49929207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9202025Medicaid
TN1532794Medicaid
AR198892001Medicaid
TN10316I5385Medicare PIN