Provider Demographics
NPI:1831124783
Name:YOUNG, MARC CHRISTOPHER (DPM)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:CHRISTOPHER
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-5239
Mailing Address - Country:US
Mailing Address - Phone:775-783-1122
Mailing Address - Fax:775-783-0868
Practice Address - Street 1:1422 MISSION ST
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410
Practice Address - Country:US
Practice Address - Phone:775-783-1122
Practice Address - Fax:775-783-0868
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9814213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV6031210001Medicare NSC
NVV35288Medicare PIN
NVU64140Medicare UPIN