Provider Demographics
NPI:1396775979
Name:YOUNG, ROBYN G (MD)
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:G
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:PO BOX 5291
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5200
Mailing Address - Country:US
Mailing Address - Phone:207-323-7496
Mailing Address - Fax:
Practice Address - Street 1:985 ATLANTIC AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-6447
Practice Address - Country:US
Practice Address - Phone:510-748-5363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2012-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG370842084N0400X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G370840Medicare PIN