Provider Demographics
NPI:1255308672
Name:OH, YOUNG-HO (MD)
Entity Type:Individual
Prefix:
First Name:YOUNG-HO
Middle Name:
Last Name:OH
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 1:94 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-4000
Mailing Address - Country:US
Mailing Address - Phone:508-764-2772
Mailing Address - Fax:508-764-2833
Practice Address - Street 1:94 SOUTH ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-4000
Practice Address - Country:US
Practice Address - Phone:508-764-2772
Practice Address - Fax:508-764-2833
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205013207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2615923OtherAETNA HEALTH CARE
MA4779737001OtherCIGNA
MA0024375OtherNEIGHBORHOOD HEALTH PLAN
MA09-02806OtherUNITED HEALTH
MA172450OtherHARVARD PILGRIM HEALTH
MA0138126Medicaid
MAJ23603OtherBLUE CROSS BLUE SHIELD
MA62252OtherFALLON SELECT
MA200042843OtherRAIL ROAD MEDICARE
MA205013OtherTUFTS
MDA32586Medicare ID - Type UnspecifiedMEDICARE
MA09-02806OtherUNITED HEALTH
MAA3258601Medicare PIN