Provider Demographics
NPI:1245461516
Name:YOUNG, MELANIE MAY (PA)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:MAY
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:TOLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 749495
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9495
Mailing Address - Country:US
Mailing Address - Phone:239-432-8331
Mailing Address - Fax:813-321-1296
Practice Address - Street 1:8301 HARCOURT RD STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2082
Practice Address - Country:US
Practice Address - Phone:317-415-6600
Practice Address - Fax:317-415-6649
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001141A363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400061150Medicare PIN