Provider Demographics
NPI:1801815394
Name:YOUNG, SHERRI A (DO)
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:A
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:304-744-2300
Mailing Address - Fax:304-744-8195
Practice Address - Street 1:313 MACCORKLE AVE SW
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-1263
Practice Address - Country:US
Practice Address - Phone:304-744-2300
Practice Address - Fax:304-744-8195
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV2069207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00767043OtherRR MEDICARE
OH2667074Medicaid
001948966OtherMOUNTAIN STATE BCBS
OH2667074OtherOH MEDICAID MOLINA
WV3810005862Medicaid
YO4200063Medicare PIN