Provider Demographics
NPI:1568731636
Name:YOUNGREN, MARGUERITE NICOLA (MD)
Entity type:Individual
Prefix:DR
First Name:MARGUERITE
Middle Name:NICOLA
Last Name:YOUNGREN
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 1:580 COTTAGE GROVE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3088
Mailing Address - Country:US
Mailing Address - Phone:860-243-8709
Mailing Address - Fax:
Practice Address - Street 1:580 COTTAGE GROVE RD STE 107
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3088
Practice Address - Country:US
Practice Address - Phone:860-243-8709
Practice Address - Fax:860-243-8259
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CT78958207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine