Provider Demographics
NPI:1295837664
Name:YOUNG, KEVIN IAN (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:IAN
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 1:103 BOULDER POINT DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-3168
Mailing Address - Country:US
Mailing Address - Phone:603-536-1881
Mailing Address - Fax:603-238-2198
Practice Address - Street 1:103 BOULDER POINT DR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-3168
Practice Address - Country:US
Practice Address - Phone:603-536-1881
Practice Address - Fax:603-238-2198
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH82080156Medicaid
NH0108074YPNH01OtherANTHEM
NHRE1015Medicare ID - Type Unspecified