Healthcare Provider Details

I. General information

NPI: 1861028862
Provider Name (Legal Business Name): JASON YOUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2020
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE
BOSTON MA
02215-5491
US

IV. Provider business mailing address

51 MOUNT VERNON ST UNIT 4
BOSTON MA
02108-1331
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-3940
  • Fax:
Mailing address:
  • Phone: 650-862-6151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number1861028862
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: