Provider Demographics
NPI:1760408850
Name:YOUNG, ELLEN LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:LOUISE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:YOUNG-ZINECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4545 CORDATA PKWY
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-7123
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 NE NEFF RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6015
Practice Address - Country:US
Practice Address - Phone:541-706-6892
Practice Address - Fax:541-706-6813
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039263208M00000X, 207R00000X, 207R00000X
COCO45267207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1760408850Medicaid
WA8554156Medicaid
WA1760408850Medicaid
WAG8889090Medicare PIN
COC808960Medicare PIN
WAG8889090Medicare PIN
WA0259444OtherL&I AND CRIME VICTIMS
AKK160539Medicare UPIN
OR269815OtherL&I
WA7159997OtherAETNA
OR021089017OtherREGENCE - BC/BS
ORR144102Medicare UPIN
WA1760408850Medicaid
AKG80382Medicare UPIN
ORMCOOtherPROVIDENCE
CO02855526Medicaid