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 1:12430 PARK POTOMAC AVE UNIT N201
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-6950
Mailing Address - Country:US
Mailing Address - Phone:301-741-0328
Mailing Address - Fax:240-547-6167
Practice Address - Street 1:12430 PARK POTOMAC AVE
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-6948
Practice Address - Country:US
Practice Address - Phone:017-410-3283
Practice Address - Fax:240-547-6167
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01445213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist