Healthcare Provider Details

I. General information

NPI: 1578718292
Provider Name (Legal Business Name): HEIDI M YOUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEIDI M BAUMERT MD

II. Dates (important events)

Enumeration Date: 11/21/2008
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6225 BRANDON AVE STE 365
SPRINGFIELD VA
22150-2526
US

IV. Provider business mailing address

PO BOX 639295 DEPT 93394
CINCINNATI OH
45263-9295
US

V. Phone/Fax

Practice location:
  • Phone: 571-642-3433
  • Fax:
Mailing address:
  • Phone: 571-642-3433
  • Fax: 855-998-8571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number0101247620
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101247620
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: