Provider Demographics
NPI:1356824627
Name:TATA, KARL NEBA (KNT)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:NEBA
Last Name:TATA
Suffix:
Gender:M
Credentials:KNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 TEAGARDEN CIR APT 404
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7515
Mailing Address - Country:US
Mailing Address - Phone:240-481-7502
Mailing Address - Fax:
Practice Address - Street 1:3320 TEAGARDEN CIR APT 404
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7515
Practice Address - Country:US
Practice Address - Phone:240-481-7502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14039374U00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide