Healthcare Provider Details

I. General information

NPI: 1962587667
Provider Name (Legal Business Name): STEPHEN M YOUNG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEDICAL CENTER DR SUITE 308
SPRINGFIELD MA
01199-1619
US

IV. Provider business mailing address

280 CHESTNUT ST 2ND FLOOR
SPRINGFIELD MA
01199-1619
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-7020
  • Fax: 413-794-2670
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1902
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2213
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: