Provider Demographics
NPI:1760425532
Name:YOUNG, DESMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:DESMOND
Middle Name:
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:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-0280
Mailing Address - Country:US
Mailing Address - Phone:843-652-4800
Mailing Address - Fax:843-357-4783
Practice Address - Street 1:4057 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5032
Practice Address - Country:US
Practice Address - Phone:843-652-4800
Practice Address - Fax:843-357-4783
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC288361207RC0200X, 207RP1001X
MO2003001136207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC288361Medicaid
SCI31030Medicare UPIN
SC288361Medicaid
SCI310306287Medicare PIN
SCP00334665Medicare PIN
SCI310305879Medicare PIN