Healthcare Provider Details

I. General information

NPI: 1962326181
Provider Name (Legal Business Name): MR. THOMAS GEORGE RALPH YOUDEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 LAFAYETTE ST
SALEM MA
01970-5348
US

IV. Provider business mailing address

5 ORCHARD CIR
MARBLEHEAD MA
01945-1818
US

V. Phone/Fax

Practice location:
  • Phone: 75-022-2135
  • Fax:
Mailing address:
  • Phone: 75-022-2135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: