Provider Demographics
NPI:1104879873
Name:NUNLIST YOUNG, DONALD G (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:G
Last Name:NUNLIST YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3805 EDWARDS RD STE 360
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-1934
Mailing Address - Country:US
Mailing Address - Phone:513-871-7848
Mailing Address - Fax:513-871-3278
Practice Address - Street 1:3805 EDWARDS RD STE 360
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-1934
Practice Address - Country:US
Practice Address - Phone:513-871-7848
Practice Address - Fax:513-871-3278
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2020-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35039349207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0317302Medicaid
KY64765035Medicaid
KY64765035Medicaid
OHA75600Medicare UPIN