Provider Demographics
NPI:1518928977
Name:YOUNG, CHARLES C (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:C
Last Name:YOUNG
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 1:5055 SEMINARY ROAD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-2026
Mailing Address - Country:US
Mailing Address - Phone:703-931-5635
Mailing Address - Fax:703-931-6972
Practice Address - Street 1:5055 SEMINARY ROAD
Practice Address - Street 2:SUITE 109
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-2026
Practice Address - Country:US
Practice Address - Phone:703-931-5635
Practice Address - Fax:703-931-6972
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042684208100000X
MDD0042666208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6830315Medicaid
MD190061700Medicaid
MD190061700Medicaid
578616Medicare ID - Type Unspecified