Provider Demographics
NPI:1003927989
Name:YOUNG, MARK ALLEN (MD,MBA,FACP)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD,MBA,FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5430 CAMPBELL BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162-5504
Mailing Address - Country:US
Mailing Address - Phone:410-933-8800
Mailing Address - Fax:410-933-8900
Practice Address - Street 1:5430 CAMPBELL BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:WHITE MARSH
Practice Address - State:MD
Practice Address - Zip Code:21162-5500
Practice Address - Country:US
Practice Address - Phone:410-933-8800
Practice Address - Fax:410-933-8900
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD420862081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD494QMedicare UPIN