Healthcare Provider Details

I. General information

NPI: 1184006017
Provider Name (Legal Business Name): ANDREW C YOUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2015
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 ALBANY STREET SHAPIRO 7, SUITE B
BOSTON MA
02118
US

IV. Provider business mailing address

801 ALBANY STREET FL GROUND
BOSTON MA
02119
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-8456
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number273559
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number273559
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: