Basic Information
| Provider Information | |||||||||
| NPI: | 1447243878 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 SOUTH ASHLEY DRIVE | ||||||||
| Address2: | SUITE 1500 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336025318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138996220 | ||||||||
| FaxNumber: | 8139858006 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 SOUTH ASHLEY DRIVE | ||||||||
| Address2: | SUITE 1500 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336025318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138996220 | ||||||||
| FaxNumber: | 8139858006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 04/02/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 220245 | MA | N | Other Service Providers | Specialist | 2085R0202X | A95087 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | ME111851 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | '011918500 | 05 | FL | MEDICAID | 2236171 | 01 | MA | FIRST HEALTH | OTHER | 30204317 | 01 | NH | NH MEDICAID | OTHER | 5540164 | 01 | MA | FIRST HEALTH CCN | OTHER | P00196700 | 01 | MA | RAIL ROAD MEDICARE | OTHER | 68312 | 01 | MA | HEALTHY START | OTHER | 68312 | 01 | MA | CHILDREN'S MEDICAL | OTHER | 0108933Y0MA01 | 01 | NH | NH BLUE SHIELD | OTHER | 7800325 | 01 | MA | CIGNA | OTHER | 971089 | 01 | MA | NETWORK HEALTH PLAN | OTHER | 2045150 | 05 | MA | MEDICAID | 469315 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 90532 | 01 | MA | FALLON | OTHER | AA17331 | 01 | MA | HARVARD PILGRIM HEALTH CA | OTHER | J27411 | 01 | MA | BLUE CROSS/BLUE SHIELD | OTHER | 3551415 | 01 | MA | AETNA/US HEALTHCARE | OTHER |