Provider Demographics
NPI:1053375329
Name:YOUNAN, EMAD S (MD)
Entity type:Individual
Prefix:
First Name:EMAD
Middle Name:S
Last Name:YOUNAN
Suffix:
Gender:M
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 3443
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01961-3443
Mailing Address - Country:US
Mailing Address - Phone:978-532-2650
Mailing Address - Fax:
Practice Address - Street 1:25 CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7901
Practice Address - Country:US
Practice Address - Phone:978-532-2652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205009207L00000X, 207LP2900X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ23136OtherBLUE CROSS/BLUE SHIELD
MA277198OtherHARVARD PILGRIM HEALTHCAR
MA0122190Medicaid
MAP00128250OtherRAILROAD MEDICARE
MA205009OtherTUFTS HEALTH CARE
MA67891OtherFALLON
MAP00128250OtherRAILROAD MEDICARE
A31067Medicare ID - Type Unspecified