Provider Demographics
NPI:1649279621
Name:YOUNIS, MARK S (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:YOUNIS
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:PO BOX 11795
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25339-1795
Mailing Address - Country:US
Mailing Address - Phone:866-871-7843
Mailing Address - Fax:
Practice Address - Street 1:PINNELL STREET
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-0720
Practice Address - Country:US
Practice Address - Phone:304-372-2731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY379912085R0202X
OH25.0000062085R0202X
WV170872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0120068000Medicaid
KY000000390831OtherBCBS
WV000164081OtherBCBS
OH2047207Medicaid
KY64942055Medicaid
WVP00012899OtherRAILROAD MEDICARE
KY0766801Medicare ID - Type Unspecified
OH2047207Medicaid