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General NPI Number Information
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NPI Number | 1053392399
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Entity Type | Individual
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Provider Name | ROBERT J YOUNG MD
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Gender | Male
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Dates
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Enumeration Date | 11/11/2005
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Last Update Date | 07/20/2021
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Provider Practice Location Address
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Address Line | 3698 S MAIN ST
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City | BLACKSBURG
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State | VA
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Zip | 24060-7015
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Country | US
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Telephone | 540-951-7880
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Fax | 540-951-3106
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Provider Business Mailing Address
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Address Line | 1542 WHITMAN LN
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City | CHRISTIANSBURG
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State | VA
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Zip | 24073-7026
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 0101050317
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 0101-050317
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License Number State | VA
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