Provider Demographics
NPI:1255337259
Name:YOUNG, THOMAS (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
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 1:1034 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2945
Mailing Address - Country:US
Mailing Address - Phone:814-373-2335
Mailing Address - Fax:814-373-2338
Practice Address - Street 1:16792 CONNEAUT LAKE RD
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3748
Practice Address - Country:US
Practice Address - Phone:814-373-2335
Practice Address - Fax:814-373-2338
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR49094207RH0003X
KY29292207RH0003X
PAMD039841E207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50006869OtherPASSPORT
KY64000920Medicaid
CO13802780Medicaid
KY830000259OtherRAILROAD MEDICARE
UT1255337259Medicaid
UT1255337259Medicaid
KY0535202Medicare PIN
CO13802780Medicaid
KY0534608Medicare PIN
KY830000259OtherRAILROAD MEDICARE
KY64000920Medicaid