Provider Demographics
NPI:1013116086
Name:TASHA LATRICE YOUNG
Entity Type:Organization
Organization Name:TASHA LATRICE YOUNG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TASHA
Authorized Official - Middle Name:LATRICE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-741-0328
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:301-741-0328
Mailing Address - Fax:240-339-1729
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:301-741-0328
Practice Address - Fax:240-339-1729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01445310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG02545Medicare PIN