Provider Demographics
NPI:1285224287
Name:TAM, POLICAP TENGEN
Entity Type:Individual
Prefix:
First Name:POLICAP
Middle Name:TENGEN
Last Name:TAM
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 1:9101 CHERRY LN STE 212
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1116
Mailing Address - Country:US
Mailing Address - Phone:301-213-1812
Mailing Address - Fax:
Practice Address - Street 1:9101 CHERRY LN STE 212
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1116
Practice Address - Country:US
Practice Address - Phone:301-213-1812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00189812376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide