Healthcare Provider Details

I. General information

NPI: 1760425532
Provider Name (Legal Business Name): DESMOND YOUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4057 HIGHWAY 17
MURRELLS INLET SC
29576-5032
US

IV. Provider business mailing address

PO BOX 280
MURRELLS INLET SC
29576-0280
US

V. Phone/Fax

Practice location:
  • Phone: 843-652-4800
  • Fax: 843-357-4783
Mailing address:
  • Phone: 843-652-4800
  • Fax: 843-357-4783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number288361
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number2003001136
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number288361
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier288361
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: