Provider Demographics
NPI:1255399697
Name:YOUNG, WENDE W (MD)
Entity type:Individual
Prefix:
First Name:WENDE
Middle Name:W
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 SAWGRASS DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4648
Mailing Address - Country:US
Mailing Address - Phone:585-442-2190
Mailing Address - Fax:585-442-1837
Practice Address - Street 1:170 SAWGRASS DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4648
Practice Address - Country:US
Practice Address - Phone:585-442-2190
Practice Address - Fax:585-442-1837
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0896462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00452979Medicaid
D01585Medicare UPIN
NY00452979Medicaid