Provider Demographics
NPI:1639667371
Name:YOUNG, MARIELLE (MD, MPH (5/2017))
Entity Type:Individual
Prefix:DR
First Name:MARIELLE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MD, MPH (5/2017)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2696
Mailing Address - Country:US
Mailing Address - Phone:617-724-4133
Mailing Address - Fax:617-724-3947
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-2687
Practice Address - Fax:617-726-5964
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA287737208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics