Provider Demographics
NPI:1326205113
Name:YOUNG, BENJAMIN EDWARD II (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:EDWARD
Last Name:YOUNG
Suffix:II
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 1:14010 SMOKETOWN RD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4704
Mailing Address - Country:US
Mailing Address - Phone:703-580-0181
Mailing Address - Fax:703-897-8763
Practice Address - Street 1:14010 SMOKETOWN RD
Practice Address - Street 2:SUITE 117
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4704
Practice Address - Country:US
Practice Address - Phone:703-580-0181
Practice Address - Fax:703-897-8763
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA228389207R00000X
FLME112686207RG0100X
VA0101253006207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1326205113Medicaid
FL005937600Medicaid
FL005937600Medicaid
FLGD917ZMedicare PIN