Provider Demographics
NPI:1013735638
Name:YOUNG, MARY BARBARA
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BARBARA
Last Name:YOUNG
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HARR ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-3922
Mailing Address - Country:US
Mailing Address - Phone:240-308-1779
Mailing Address - Fax:
Practice Address - Street 1:101 HARR ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-3922
Practice Address - Country:US
Practice Address - Phone:240-308-1779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant