Healthcare Provider Details

I. General information

NPI: 1972575116
Provider Name (Legal Business Name): PAMELA BURKHOLDER YOUNG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MATTHEWS TOWNSHIP PKWY SUITE 100
MATTHEWS NC
28105-5402
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-1080
  • Fax: 704-384-1122
Mailing address:
  • Phone: 704-384-1080
  • Fax: 704-384-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9400280
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: