Healthcare Provider Details

I. General information

NPI: 1437156924
Provider Name (Legal Business Name): ELIZABETH YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 10/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 PLEASANT ST, SUITE 2 CONCORD OTOLARYNGOLOGY
CONCORD NH
03301-2915
US

IV. Provider business mailing address

194 PLEASANT ST, SUITE 2 CONCORD OTOLARYNGOLOGY
CONCORD NH
03301-2915
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-2353
  • Fax: 603-224-6874
Mailing address:
  • Phone: 603-224-2353
  • Fax: 603-224-6874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA75
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: