Organization
'YOUNG C FAN MD'
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. YOUNG C FAN M.D. (PRESIDENT)
(814) 827-4602
Entity
Organization
Contact information
Practice address
119 E MECHANIC ST, TITUSVILLE, PA 16354-2161
(814) 827-4602
(814) 827-6322
Mailing address
119 E MECHANIC ST, TITUSVILLE, PA 16354-2161
(814) 827-4602
(814) 827-6322
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD033897L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006010740001
—
PA
01
—
032140
PENNSYLVANIA BLUE SHIELD
PA
Enumeration date
02/06/2006
Last updated
08/22/2020
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