Healthcare Provider Details

I. General information

NPI: 1891265443
Provider Name (Legal Business Name): CAROLYN TE YOUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 NARRAGANSETT BLVD
CRANSTON RI
02905
US

IV. Provider business mailing address

1320 NARRAGANSETT BLVD
CRANSTON RI
02905-5142
US

V. Phone/Fax

Practice location:
  • Phone: 401-443-6159
  • Fax:
Mailing address:
  • Phone: 401-461-3006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberMD8912
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License NumberMD8912
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number278133
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: