Healthcare Provider Details

I. General information

NPI: 1215445788
Provider Name (Legal Business Name): CHARLES YOUNG NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

861 E ALLEGHENY AVE
PHILADELPHIA PA
19134-2401
US

IV. Provider business mailing address

4417 N 6TH ST
PHILADELPHIA PA
19140-2319
US

V. Phone/Fax

Practice location:
  • Phone: 215-831-1100
  • Fax:
Mailing address:
  • Phone: 215-302-3150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP018575
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: