Healthcare Provider Details

I. General information

NPI: 1316256415
Provider Name (Legal Business Name): CHARLES YOUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 VINE ST
CINCINNATI OH
45220-2213
US

IV. Provider business mailing address

3200 VINE ST
CINCINNATI OH
45220-2213
US

V. Phone/Fax

Practice location:
  • Phone: 513-304-3552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number35127116
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35127116
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: