Healthcare Provider Details

I. General information

NPI: 1841425600
Provider Name (Legal Business Name): NATHAN JOHN YOUNG DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2009
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 WALNUT AVE SW
ROANOKE VA
24016-4723
US

IV. Provider business mailing address

222 WALNUT AVE SW
ROANOKE VA
24016-4723
US

V. Phone/Fax

Practice location:
  • Phone: 540-344-3668
  • Fax: 540-343-2457
Mailing address:
  • Phone: 540-344-3668
  • Fax: 540-343-2457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103301073
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: