Healthcare Provider Details

I. General information

NPI: 1295337301
Provider Name (Legal Business Name): JOSEPH YOUNG LSA, CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 LOUGHBORO RD NW
WASHINGTON DC
20016-2633
US

IV. Provider business mailing address

2602 BRINKLEY RD APT 1006
FORT WASHINGTON MD
20744-1918
US

V. Phone/Fax

Practice location:
  • Phone: 202-537-4000
  • Fax:
Mailing address:
  • Phone: 301-395-3954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA0241
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: