Healthcare Provider Details

I. General information

NPI: 1316047210
Provider Name (Legal Business Name): TANYA MARIE JUDD DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OF VETERANS AFFAIRS MEDICAL CTR 50 IRVING STREET NW
WASHINGTON DC
20422-0001
US

IV. Provider business mailing address

1037 TREELAND WAY
UPPER MARLBORO MD
20774-1647
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-8000
  • Fax:
Mailing address:
  • Phone: 200-422-9525
  • Fax: 202-745-8293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO1000033
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number01389
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: