Healthcare Provider Details

I. General information

NPI: 1114587441
Provider Name (Legal Business Name): MARIAN YOUNGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 JACKSON ST
LOWELL MA
01852-2103
US

IV. Provider business mailing address

455 TOLL GATE RD
WARWICK RI
02886-2759
US

V. Phone/Fax

Practice location:
  • Phone: 978-937-9700
  • Fax: 978-221-6728
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD18751
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: