Provider Demographics
NPI:1124589551
Name:YOUNG, EMILY LOUISE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:LOUISE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6858 OLD DOMINION DR
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3899
Mailing Address - Country:US
Mailing Address - Phone:703-847-9800
Mailing Address - Fax:703-356-7074
Practice Address - Street 1:6858 OLD DOMINION DR
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3899
Practice Address - Country:US
Practice Address - Phone:703-847-9800
Practice Address - Fax:703-356-7074
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-006770207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110-006770OtherVA LICENSE PRACTICE AS A PA