Provider Demographics
NPI:1376528356
Name:YOUNG, ELAINE M (MD)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701
Mailing Address - Country:US
Mailing Address - Phone:304-525-6132
Mailing Address - Fax:304-697-0471
Practice Address - Street 1:1411 6TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2420
Practice Address - Country:US
Practice Address - Phone:304-525-6132
Practice Address - Fax:304-697-0471
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16077207N00000X
SC21723207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0069955000Medicaid
001721516OtherBLUE CROSS BLUE SHIELD
550724241OtherCOMMERCIAL INSURANCE
WV0069955000Medicaid
E59967Medicare UPIN