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NPI Code Detail

MEDICARE: DAWN MARIE GAVAGAN SIMALA YOUNG D.O.

MEDICARE: DAWN MARIE GAVAGAN SIMALA YOUNG D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician2022-02976NC
2207Q00000XFamily Medicine Physician02001458IN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P01609365OTHERINRR PTAN (MIAMI)
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3000000984586OTHERINBCBS (MIAMI)

General Provider Information

NPI Number : 1750368726
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAWN MARIE GAVAGAN SIMALA YOUNG D.O.
Provider Business Mailing Address
First Line : PO BOX 60447
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0447
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 501 OLDE WATERFORD WAY
Second Line :
City : LELAND
State : NC
Zip : 28451-4117
Country : US
Telephone Number : 910-408-1130
Fax Number : 910-408-1135
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2005
Last Update Date : 01/02/2026

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