Provider Demographics
NPI:1053493791
Name:YOUNG, THOMAS L (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:DEPT 888196
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37995-0001
Mailing Address - Country:US
Mailing Address - Phone:865-670-6199
Mailing Address - Fax:865-670-6198
Practice Address - Street 1:1928 ALCOA HWY
Practice Address - Street 2:STE 105
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1502
Practice Address - Country:US
Practice Address - Phone:865-305-9595
Practice Address - Fax:865-305-6556
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD12475207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3016540Medicaid
TN100013534Medicare PIN
TN3016540Medicare PIN
TNA98054Medicare UPIN