Provider Demographics
NPI:1730917246
Name:YOUNG, TARA (PHD, RD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PHD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13301 KATRINKA DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4734
Mailing Address - Country:US
Mailing Address - Phone:240-444-2962
Mailing Address - Fax:
Practice Address - Street 1:13301 KATRINKA DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-4734
Practice Address - Country:US
Practice Address - Phone:240-444-2962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD863298133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered