Provider Demographics
NPI:1497837496
Name:YOUNG, CARLA L (MD)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:L
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1600 W COLLEGE ST
Mailing Address - Street 2:SUITE 685
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3580
Mailing Address - Country:US
Mailing Address - Phone:682-223-1406
Mailing Address - Fax:682-223-1346
Practice Address - Street 1:1600 W COLLEGE ST
Practice Address - Street 2:SUITE 685
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3580
Practice Address - Country:US
Practice Address - Phone:682-223-1406
Practice Address - Fax:682-223-1346
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP1154208100000X
CAA80532174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A805320Medicaid
TX344740YTNBOtherMEDICARE PTAN
TX290680202Medicaid
CAH51028Medicare UPIN
CA00A805320Medicaid