Provider Demographics
NPI:1598287880
Name:TCHAMOLOGNE, GUY B
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:B
Last Name:TCHAMOLOGNE
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 1:309 HANNES ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1104
Mailing Address - Country:US
Mailing Address - Phone:301-523-1953
Mailing Address - Fax:
Practice Address - Street 1:3800 LOTTSFORD VISTA RD
Practice Address - Street 2:
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-4018
Practice Address - Country:US
Practice Address - Phone:301-459-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-09
Last Update Date:2017-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR215679163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse