Provider Demographics
NPI:1477508729
Name:YOUNG, PAULA D I (MD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:D
Last Name:YOUNG
Suffix:I
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2280 GRAND AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3164
Mailing Address - Country:US
Mailing Address - Phone:516-398-0029
Mailing Address - Fax:516-378-1045
Practice Address - Street 1:2280 GRAND AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3164
Practice Address - Country:US
Practice Address - Phone:516-398-0029
Practice Address - Fax:516-378-1045
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2010-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY178888207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01663161Medicaid
2156275OtherAETNA
NY10779768OtherCAQH
NY30L87OtherBCBS
1423639OtherUNITEDHEALTHCARE
NYP1959239OtherOXFORD
0007098316OtherAETNA LIFE INS CO
NY30L87OtherBCBS
NY11-3449468OtherTIN
1423639OtherUNITEDHEALTHCARE