Provider Demographics
NPI:1316047210
Name:JUDD, TANYA MARIE (DPM)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:MARIE
Last Name:JUDD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1037 TREELAND WAY
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1647
Mailing Address - Country:US
Mailing Address - Phone:200-422-9525
Mailing Address - Fax:202-745-8293
Practice Address - Street 1:OF VETERANS AFFAIRS MEDICAL CTR
Practice Address - Street 2:50 IRVING STREET NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20422-0001
Practice Address - Country:US
Practice Address - Phone:202-745-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPO1000033213ES0131X
MD01389213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCU96486Medicare UPIN