Provider Demographics
NPI:1306000880
Name:YOUNG, DENISE NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:NICOLE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:303 GREAT TEAYS BLVD
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-9553
Mailing Address - Country:US
Mailing Address - Phone:304-757-8803
Mailing Address - Fax:304-757-6904
Practice Address - Street 1:303 GREAT TEAYS BLVD
Practice Address - Street 2:
Practice Address - City:SCOTT DEPOT
Practice Address - State:WV
Practice Address - Zip Code:25560-9553
Practice Address - Country:US
Practice Address - Phone:304-757-8803
Practice Address - Fax:304-757-6904
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV232812080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine