Provider Demographics
NPI:1396853180
Name:YOUNGER, BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:YOUNGER
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 1:2752 ERIE AVE
Mailing Address - Street 2:SUITE #7
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208
Mailing Address - Country:US
Mailing Address - Phone:513-871-3302
Mailing Address - Fax:513-871-3415
Practice Address - Street 1:2752 ERIE AVE
Practice Address - Street 2:SUITE #7
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208
Practice Address - Country:US
Practice Address - Phone:513-871-3302
Practice Address - Fax:513-871-3415
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35045874207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AY1175872OtherDEA
AY1175872OtherDEA
A80043Medicare UPIN