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General NPI Number Information
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NPI Number | 1518928977
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Entity Type | Individual
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Provider Name | CHARLES C YOUNG MD
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Gender | Male
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Dates
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Enumeration Date | 03/28/2006
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Last Update Date | 09/19/2013
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Provider Practice Location Address
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Address Line | 5055 SEMINARY ROAD SUITE 109
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City | ALEXANDRIA
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State | VA
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Zip | 22311-2026
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Country | US
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Telephone | 703-931-5635
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Fax | 703-931-6972
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Provider Business Mailing Address
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Address Line | 5055 SEMINARY ROAD SUITE 109
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City | ALEXANDRIA
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State | VA
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Zip | 22311-2026
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Country | US
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Telephone | 703-931-5635
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Fax | 703-931-6972
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 0101042684
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | D0042666
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License Number State | MD
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