Healthcare Provider Details

I. General information

NPI: 1790774073
Provider Name (Legal Business Name): GREGORY ROBERT YOUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 TOLL GATE RD
WARWICK RI
02886-2759
US

IV. Provider business mailing address

275 MARTINE ST SUITE 301
FALL RIVER MA
02723-1516
US

V. Phone/Fax

Practice location:
  • Phone: 401-737-7000
  • Fax:
Mailing address:
  • Phone: 508-675-4689
  • Fax: 508-675-7905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD10478
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number034430
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: