Provider Demographics
NPI:1962817825
Name:YOUNG, GARY TREVOR (PA-C)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:TREVOR
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:127 ONEIDA VALLEY RD STE 201
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-2239
Mailing Address - Country:US
Mailing Address - Phone:724-431-4328
Mailing Address - Fax:724-431-2288
Practice Address - Street 1:127 ONEIDA VALLEY RD STE 202
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-2239
Practice Address - Country:US
Practice Address - Phone:724-282-4370
Practice Address - Fax:724-431-2288
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2018-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PATMA052929363AS0400X
PA363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031853870001Medicaid