Healthcare Provider Details

I. General information

NPI: 1033118419
Provider Name (Legal Business Name): DARA TASH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

251 E BALTIMORE ST
HAGERSTOWN MD
21740-6144
US

IV. Provider business mailing address

251 E BALTIMORE ST
HAGERSTOWN MD
21740-6144
US

V. Phone/Fax

Practice location:
  • Phone: 301-416-8600
  • Fax: 301-416-8602
Mailing address:
  • Phone: 301-416-8600
  • Fax: 301-416-8602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0052418
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: