Provider Demographics
NPI:1457597163
Name:YOUNG, JONATHAN P (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:P
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 WOODMAN DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432-1400
Mailing Address - Country:US
Mailing Address - Phone:937-252-2000
Mailing Address - Fax:937-252-1224
Practice Address - Street 1:540 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-1110
Practice Address - Country:US
Practice Address - Phone:937-746-4400
Practice Address - Fax:937-746-6670
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35091509207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine