Basic Information
| Provider Information | |||||||||
| NPI: | 1982604534 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | NOEL | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4102 N ROXBORO RD | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195952000 | ||||||||
| FaxNumber: | 9195952190 | ||||||||
| Practice Location | |||||||||
| Address1: | 4102 N ROXBORO ST | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277042122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195952000 | ||||||||
| FaxNumber: | 9195952190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2005 | ||||||||
| LastUpdateDate: | 10/12/2007 | ||||||||
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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 | 207W00000X | 13955 | NC | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 10462 | 01 | NC | OPTICARE | OTHER | OPH109 | 01 | NC | PRIMAHEALTH | OTHER | 28026 | 01 | NC | COMMUNITY EYE CARE | OTHER | 89813 | 01 | NC | BCBSNC | OTHER | A0775 | 01 | NC | MEDCOST | OTHER | 4221853 | 01 | NC | AETNA | OTHER | 0850160 | 01 | NC | UNITED HEALTHCARE | OTHER | 56128876725 | 01 | NC | CIGNA | OTHER | 430364 | 01 | NC | MAMSI | OTHER | 8989813 | 05 | NC | MEDICAID |