Provider Demographics
NPI:1235943408
Name:YOUNG, IVOR CONRAD (MT)
Entity type:Individual
Prefix:
First Name:IVOR
Middle Name:CONRAD
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8311 OSAGE TER
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-1758
Mailing Address - Country:US
Mailing Address - Phone:240-593-3722
Mailing Address - Fax:
Practice Address - Street 1:7701 GREENBELT RD STE 104
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-6504
Practice Address - Country:US
Practice Address - Phone:301-798-9188
Practice Address - Fax:240-261-7229
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty