Provider Demographics
NPI:1497880678
Name:YOUNG, MARCELA V (MD)
Entity Type:Individual
Prefix:
First Name:MARCELA
Middle Name:V
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 1:540 OLD HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-1969
Mailing Address - Country:US
Mailing Address - Phone:864-365-0100
Mailing Address - Fax:864-365-0110
Practice Address - Street 1:540 OLD HOWELL RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-1969
Practice Address - Country:US
Practice Address - Phone:864-365-0100
Practice Address - Fax:864-365-0110
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14183207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP5429Medicaid
SC8157Medicare PIN
E86893Medicare UPIN