Provider Demographics
NPI:1821302183
Name:YOUNG, ELISABETH HELEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:HELEN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 CANDY WOODS DR
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-2289
Mailing Address - Country:US
Mailing Address - Phone:330-707-9007
Mailing Address - Fax:330-758-8995
Practice Address - Street 1:5190 MARKET ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-2131
Practice Address - Country:US
Practice Address - Phone:330-788-1992
Practice Address - Fax:330-788-1998
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-4833207R00000X, 207RH0002X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0812937Medicaid
OHY00684531Medicare PIN
OHE68495Medicare UPIN