Healthcare Provider Details

I. General information

NPI: 1902341647
Provider Name (Legal Business Name): MARY E YOUNG M.D., DRPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10119 GARY RD
POTOMAC MD
20854-4109
US

IV. Provider business mailing address

10119 GARY RD
POTOMAC MD
20854-4109
US

V. Phone/Fax

Practice location:
  • Phone: 301-299-7628
  • Fax: 301-299-1711
Mailing address:
  • Phone: 301-299-7628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM23513
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: