Provider Demographics
NPI:1619933629
Name:YOUNG, CASEY D (PA)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:D
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 DAYTON SPRINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-8538
Mailing Address - Country:US
Mailing Address - Phone:937-408-2682
Mailing Address - Fax:937-717-4656
Practice Address - Street 1:1 WYOMING ST
Practice Address - Street 2:TRAUMA CENTER
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2722
Practice Address - Country:US
Practice Address - Phone:937-208-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50002030363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P99923Medicare UPIN
YOPA21761Medicare ID - Type Unspecified
OHYOPA21772Medicare PIN