Provider Demographics
NPI:1700842143
Name:YOUNG, LARRY (PA)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:415 MORRIS ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1842
Mailing Address - Country:US
Mailing Address - Phone:304-344-3551
Mailing Address - Fax:304-342-6927
Practice Address - Street 1:415 MORRIS ST
Practice Address - Street 2:SUITE 400
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1842
Practice Address - Country:US
Practice Address - Phone:304-344-3551
Practice Address - Fax:304-342-6927
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV89363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVS58173Medicare UPIN
WVPA11701Medicare ID - Type Unspecified