Provider Demographics
NPI:1285604561
Name:YOUNG, STEPHANIE S (DO)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:S
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 LOVELL AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-1855
Mailing Address - Country:US
Mailing Address - Phone:814-846-5972
Mailing Address - Fax:814-846-5971
Practice Address - Street 1:171 LOVELL AVE STE 102
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-1855
Practice Address - Country:US
Practice Address - Phone:814-846-5972
Practice Address - Fax:814-846-5971
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009334L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017461380002Medicaid
056175OtherGROUP BILLING PROVIDER #
056175OtherGROUP BILLING PROVIDER #
PA012535EQWMedicare ID - Type Unspecified