Provider Demographics
NPI:1508126335
Name:TAMUKONG, MARTIN CHEH (RN)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:CHEH
Last Name:TAMUKONG
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8301 SWEET BRENDA CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4924
Mailing Address - Country:US
Mailing Address - Phone:301-523-6233
Mailing Address - Fax:
Practice Address - Street 1:8301 SWEET BRENDA CT
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4924
Practice Address - Country:US
Practice Address - Phone:301-523-6233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-27
Last Update Date:2012-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR183064163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse