Healthcare Provider Details

I. General information

NPI: 1740281849
Provider Name (Legal Business Name): IRA SANDERS YOUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8503 ARLINGTON BLVD #310
FAIRFAX VA
22031-4628
US

IV. Provider business mailing address

8503 ARLINGTON BLVD #310
FAIRFAX VA
22031-4628
US

V. Phone/Fax

Practice location:
  • Phone: 703-208-4200
  • Fax: 703-876-1799
Mailing address:
  • Phone: 703-208-4200
  • Fax: 703-876-1799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101017574
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: