Provider Demographics
NPI:1326087941
Name:YOUNG, MARTIN C (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:C
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 1:2913 BETIN AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7257
Mailing Address - Country:US
Mailing Address - Phone:318-651-9945
Mailing Address - Fax:318-410-0680
Practice Address - Street 1:2915 BETIN AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7257
Practice Address - Country:US
Practice Address - Phone:318-561-9945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD09436R2080P0205X
LA09436R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1937657Medicaid
LA5R212Medicare PIN
LA1937657Medicaid