Healthcare Provider Details

I. General information

NPI: 1225298664
Provider Name (Legal Business Name): JENNIFER LEE YOUNG M.D., MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 QUINCE ORCHARD ROAD SUITE 350
GAITHERSBURG MD
20878
US

IV. Provider business mailing address

10801 LOCKWOOD DR SUITE 325
SILVER SPRING MD
20901-1556
US

V. Phone/Fax

Practice location:
  • Phone: 301-926-3633
  • Fax: 301-948-9884
Mailing address:
  • Phone: 301-754-3050
  • Fax: 301-681-0789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0069199
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: