Provider Demographics
NPI:1750552030
Name:MARC CHRISTOPHER YOUNG CHARTERED
Entity type:Organization
Organization Name:MARC CHRISTOPHER YOUNG CHARTERED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:C
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:775-783-1122
Mailing Address - Street 1:1482 US HIGHWAY 395 N
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-5208
Mailing Address - Country:US
Mailing Address - Phone:775-783-1122
Mailing Address - Fax:775-783-0868
Practice Address - Street 1:1482 US HIGHWAY 395 N
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-5208
Practice Address - Country:US
Practice Address - Phone:775-783-1122
Practice Address - Fax:775-783-0868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9814332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVU64140Medicare UPIN
NVV35288Medicare PIN
NV1326210001Medicare NSC