Healthcare Provider Details

I. General information

NPI: 1619933629
Provider Name (Legal Business Name): CASEY D YOUNG PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST TRAUMA CENTER
DAYTON OH
45409-2722
US

IV. Provider business mailing address

4750 DAYTON SPRINGFIELD RD
SPRINGFIELD OH
45502-8538
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-8000
  • Fax:
Mailing address:
  • Phone: 937-408-2682
  • Fax: 937-717-4656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50002030
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: