Provider Demographics
NPI:1659836658
Name:TASSAH, MAURICE AWAH
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:AWAH
Last Name:TASSAH
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 1:9407 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3218
Mailing Address - Country:US
Mailing Address - Phone:240-821-4814
Mailing Address - Fax:
Practice Address - Street 1:9407 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-3218
Practice Address - Country:US
Practice Address - Phone:240-821-4814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14244374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty