Provider Demographics
NPI:1942218672
Name:YOUNG, MARK R (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:R
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 1:60 MESSENGER ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02762-2258
Mailing Address - Country:US
Mailing Address - Phone:508-316-7438
Mailing Address - Fax:508-316-7117
Practice Address - Street 1:60 MESSENGER ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:MA
Practice Address - Zip Code:02762
Practice Address - Country:US
Practice Address - Phone:508-316-7438
Practice Address - Fax:508-316-7117
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77096207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA70240OtherHPHC
0101050OtherUHC
MA3114627Medicaid
MA077096OtherTUFTS
MA361OtherFALLON
002748OtherRI BLUE CHIP
MAB10096301OtherCIGNA
MAJ30085OtherMABC
MA361OtherFALLON
MAJ30085OtherMABC