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General NPI Number Information
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NPI Number | 1336782614
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Entity Type | Individual
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Provider Name | DONOVAN YOUNG
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Gender | Male
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Dates
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Enumeration Date | 10/19/2019
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 15459 ANNAPOLIS RD
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City | BOWIE
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State | MD
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Zip | 20715-1847
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Country | US
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Telephone | 240-544-0676
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Fax |
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Provider Business Mailing Address
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Address Line | 307 COVE RD
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City | RIVA
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State | MD
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Zip | 21140-1225
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Country | US
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Telephone | 410-490-2755
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 62441
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0007680
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License Number State | MD
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