MEDICARE: ERIC SAMUEL YOUNG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	22220	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174567077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC SAMUEL YOUNG M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3239
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29502-3239
Country	:	US
Telephone Number	:	843-399-9774
Fax Number	:	843-399-8657

Provider Business Practice Location Address
First Line	:	3980 HIGHWAY 9 E
Second Line	:	SUITE 100-C
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-8163
Country	:	US
Telephone Number	:	843-399-9774
Fax Number	:	843-399-8657

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	06/15/2016

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