MEDICARE: POLLY T YOUNG MD

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	207Q00000X	Family Medicine Physician	G28119	CA

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

General Provider Information

NPI Number	:	1245222744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	POLLY T YOUNG MD

Provider Business Mailing Address
First Line	:	3100 TELEGRAPH AVE
Second Line	:	#2109 EAST BAY FAMILY PRACTICE MEDICAL GROUP INC
City	:	OAKLAND
State	:	CA
Zip	:	94609-3210
Country	:	US
Telephone Number	:	510-645-9900
Fax Number	:	510-645-9919

Provider Business Practice Location Address
First Line	:	3100 TELEGRAPH AVE
Second Line	:	#2109 EAST BAY FAMILY PRACTICE MEDICAL GROUP INC
City	:	OAKLAND
State	:	CA
Zip	:	94609-3210
Country	:	US
Telephone Number	:	510-645-9900
Fax Number	:	510-645-9919

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	07/08/2007

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Directions to “ POLLY T YOUNG MD” Practice Location

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