Provider Demographics
NPI:1053451344
Name:YOUNG, TASHA LATRICE (DPM)
Entity Type:Individual
Prefix:DR
First Name:TASHA
Middle Name:LATRICE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:LATRICE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4304 ARABELLA CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-9343
Mailing Address - Country:US
Mailing Address - Phone:703-298-4064
Mailing Address - Fax:571-291-6135
Practice Address - Street 1:4304 ARABELLA CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-9343
Practice Address - Country:US
Practice Address - Phone:703-298-4064
Practice Address - Fax:571-291-6135
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01445213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery