Healthcare Provider Details

I. General information

NPI: 1053392399
Provider Name (Legal Business Name): ROBERT J YOUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 07/20/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3698 S MAIN ST
BLACKSBURG VA
24060-7015
US

IV. Provider business mailing address

1542 WHITMAN LN
CHRISTIANSBURG VA
24073-7026
US

V. Phone/Fax

Practice location:
  • Phone: 540-951-7880
  • Fax: 540-951-3106
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number0101050317
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0101-050317
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: