Provider Demographics
NPI:1437174489
Name:YOUNG, ANDREA J (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 SE MAIN ST STE 224
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2469
Mailing Address - Country:US
Mailing Address - Phone:503-261-6961
Mailing Address - Fax:503-261-6959
Practice Address - Street 1:10000 SE MAIN ST STE 224
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2469
Practice Address - Country:US
Practice Address - Phone:503-261-6961
Practice Address - Fax:503-261-6959
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045467207X00000X, 207XX0005X
ORMD189771207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1010353Medicaid
WAG8902413Medicare PIN