Provider Demographics
NPI:1053889022
Name:NGO, TATA TEREAUS
Entity type:Individual
Prefix:
First Name:TATA
Middle Name:TEREAUS
Last Name:NGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7910 PIEDMONT AVE
Mailing Address - Street 2:
Mailing Address - City:GLENARDEN
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1739
Mailing Address - Country:US
Mailing Address - Phone:240-615-7740
Mailing Address - Fax:
Practice Address - Street 1:8722 MCLAIN AVEUNE
Practice Address - Street 2:
Practice Address - City:GLENARDEN
Practice Address - State:MD
Practice Address - Zip Code:20706-2070
Practice Address - Country:US
Practice Address - Phone:301-832-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14097374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide