Provider Demographics
NPI:1417073743
Name:YOUNG, JOHN LEONARD (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LEONARD
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 SILVER ST
Mailing Address - Street 2:P.O. BOX 351
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3940
Mailing Address - Country:US
Mailing Address - Phone:860-262-5868
Mailing Address - Fax:860-262-5650
Practice Address - Street 1:1000 SILVER ST
Practice Address - Street 2:CONNECTICUT VALLEY HOSPITAL
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3940
Practice Address - Country:US
Practice Address - Phone:860-262-5868
Practice Address - Fax:860-262-5650
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0215862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG09420Medicare UPIN