Provider Demographics
NPI:1104179399
Name:TINGHO, LEROY EUGENE
Entity Type:Individual
Prefix:
First Name:LEROY
Middle Name:EUGENE
Last Name:TINGHO
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 1:3119 81ST AVE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2702
Mailing Address - Country:US
Mailing Address - Phone:301-455-8419
Mailing Address - Fax:
Practice Address - Street 1:3119 81ST AVE
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-2702
Practice Address - Country:US
Practice Address - Phone:301-455-8419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide