Provider Demographics
NPI:1033118419
Name:TASH, DARA (MD)
Entity Type:Individual
Prefix:DR
First Name:DARA
Middle Name:
Last Name:TASH
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 1:251 E BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6144
Mailing Address - Country:US
Mailing Address - Phone:301-416-8600
Mailing Address - Fax:301-416-8602
Practice Address - Street 1:251 E BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6144
Practice Address - Country:US
Practice Address - Phone:301-416-8600
Practice Address - Fax:301-416-8602
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2010-07-12
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
MDD0052418174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD170200900Medicaid
F41502Medicare UPIN
MD170200900Medicaid