Healthcare Provider Details

I. General information

NPI: 1174798227
Provider Name (Legal Business Name): COURTNEY RENEE YOUNG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 TRACE DR
LANCASTER OH
43130-4151
US

IV. Provider business mailing address

697 THOMAS LN
COLUMBUS OH
43214-3931
US

V. Phone/Fax

Practice location:
  • Phone: 740-654-6300
  • Fax: 740-654-0106
Mailing address:
  • Phone: 614-566-4398
  • Fax: 614-566-6843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.089982
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: