Provider Demographics
NPI:1235339979
Name:YOUNG, NICOLAS ALEXANDER (DO)
Entity Type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:ALEXANDER
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:PO BOX 770920
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-0041
Mailing Address - Country:US
Mailing Address - Phone:440-777-3500
Mailing Address - Fax:
Practice Address - Street 1:25757 LORAIN RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3327
Practice Address - Country:US
Practice Address - Phone:440-777-3500
Practice Address - Fax:440-716-2362
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2016-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.009045207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2902881Medicaid
OH4255942Medicare PIN