Provider Demographics
NPI:1750353389
Name:YOUNG, VASSILIA D (MD)
Entity type:Individual
Prefix:DR
First Name:VASSILIA
Middle Name:D
Last Name:YOUNG
Suffix:
Gender:F
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:PO BOX 6540
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-6540
Mailing Address - Country:US
Mailing Address - Phone:605-341-5565
Mailing Address - Fax:605-341-5595
Practice Address - Street 1:7236 JORDAN DR STE 101
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-8740
Practice Address - Country:US
Practice Address - Phone:605-341-5565
Practice Address - Fax:605-341-5595
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4069207N00000X, 207ND0101X, 207ND0900X, 207NP0225X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY116997100Medicaid
SD5900103Medicaid
SD0040886OtherWELLMARK BCBS NUMBER
SD460461314OtherTRICARE NUMBER
WY311267OtherWYOMING BCBS NUMBER
NE46046131400Medicaid
WY311267OtherWYOMING BCBS NUMBER
SD5900103Medicaid
SD070016344Medicare ID - Type UnspecifiedRAILROAD MEDICARE NUMBER
SD5900103Medicaid