Provider Demographics
NPI:1639161946
Name:YOUNG, CHRISTOPHER COLIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:COLIN
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 WELLINGTON AVE STE C
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7704
Mailing Address - Country:US
Mailing Address - Phone:910-763-9334
Mailing Address - Fax:910-763-9339
Practice Address - Street 1:1606 WELLINGTON AVE STE C
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7704
Practice Address - Country:US
Practice Address - Phone:910-763-9334
Practice Address - Fax:910-763-9339
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC510213ES0131X
NC400213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890800TMedicaid
U63999Medicare UPIN
NC890800TMedicaid