Healthcare Provider Details

I. General information

NPI: 1841255882
Provider Name (Legal Business Name): VINCENT K YOUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: VINCENT K YOUNG MD

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 OLD YORK RD KLEIN 205
PHILADELPHIA PA
19141-3030
US

IV. Provider business mailing address

PO BOX 8500-8735
PHILADELPHIA PA
19178-8735
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-7150
  • Fax: 215-456-2379
Mailing address:
  • Phone: 215-456-7000
  • Fax: 215-254-2599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD035544E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: