Healthcare Provider Details

I. General information

NPI: 1528058161
Provider Name (Legal Business Name): RICHARD S YOUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 ROUTE 3
DEDEDO GU
96929-6911
US

IV. Provider business mailing address

133 ROUTE 3
DEDEDO GU
96929-6911
US

V. Phone/Fax

Practice location:
  • Phone: 671-645-5500
  • Fax: 671-645-5549
Mailing address:
  • Phone: 671-645-5500
  • Fax: 671-645-5549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD13254
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberM-1965
License Number StateGU
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberM-1965
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: