Provider Demographics
NPI:1497184469
Name:TAANGUE, BRIDGWATER (HHA)
Entity Type:Individual
Prefix:MR
First Name:BRIDGWATER
Middle Name:
Last Name:TAANGUE
Suffix:
Gender:M
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 OLD COLUMBIA PIKE
Mailing Address - Street 2:APT 604
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2579
Mailing Address - Country:US
Mailing Address - Phone:240-640-1512
Mailing Address - Fax:
Practice Address - Street 1:11700 OLD COLUMBIA PIKE
Practice Address - Street 2:APT 604
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2579
Practice Address - Country:US
Practice Address - Phone:240-640-1512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-10
Last Update Date:2013-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA9055374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide