Provider Demographics
NPI:1447345715
Name:YOUNG, JAMES RICHARD (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:RICHARD
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 1:78 ATLANTIC PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2316
Mailing Address - Country:US
Mailing Address - Phone:207-842-7708
Mailing Address - Fax:207-842-7773
Practice Address - Street 1:12 UNION ST
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2739
Practice Address - Country:US
Practice Address - Phone:207-338-2295
Practice Address - Fax:207-338-2388
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA382752084P0800X
MEMD198172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0112569Medicaid
MAM09375Medicare PIN
MEE400108666Medicare PIN
MA0112569Medicaid
MEE400108664Medicare PIN