Provider Demographics
NPI:1619230299
Name:BASSANGUEN, THOMAS DECZEM
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:DECZEM
Last Name:BASSANGUEN
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 1:13103 ELSDALE CT
Mailing Address - Street 2:#201
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20851-2034
Mailing Address - Country:US
Mailing Address - Phone:301-328-6539
Mailing Address - Fax:
Practice Address - Street 1:13103 ELSDALE CT
Practice Address - Street 2:#201
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20851-2034
Practice Address - Country:US
Practice Address - Phone:301-328-6539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide