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General NPI Number Information
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NPI Number | 1194842922
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Entity Type | Organization
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Legal Business Name | PLYMOUTH FAMILY PRACTICE CENTER
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Dates
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Enumeration Date | 03/25/2007
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Last Update Date | 01/09/2008
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Provider Practice Location Address
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Address Line | 1 WARREN ST
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City | PLYMOUTH
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State | NH
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Zip | 03264-1416
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Country | US
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Telephone | 603-536-2502
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Fax | 603-536-2503
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Provider Business Mailing Address
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Address Line | 1 WARREN ST
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City | PLYMOUTH
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State | NH
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Zip | 03264-1416
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Country | US
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Telephone | 603-536-2502
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Fax | 603-536-2503
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. KEVIN I YOUNG
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Credential | M.D.
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Telephone | 603-536-2502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 6405
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License Number State | NH
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