Provider Demographics
NPI:1891792909
Name:O'YOUNG, BRYAN J (MD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:J
Last Name:O'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 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-387-6150
Mailing Address - Fax:570-387-6185
Practice Address - Street 1:480 CENTRAL RD
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-3121
Practice Address - Country:US
Practice Address - Phone:570-387-6150
Practice Address - Fax:570-387-6185
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4543952081P2900X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01793177Medicaid
NY285818Medicare UPIN
NY100145761001Medicare UPIN
NY01793177Medicaid
NY203035-B31Medicare UPIN
NYP423912Medicare UPIN
NYOMO834Medicare UPIN
NY2799938Medicare UPIN
NY148460101Medicare UPIN
NY5300134Medicare UPIN
NY94E252Medicare PIN