Provider Demographics
NPI:1679831168
Name:TANJONG, MILTON
Entity Type:Individual
Prefix:
First Name:MILTON
Middle Name:
Last Name:TANJONG
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 1:11628 LOCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2330
Mailing Address - Country:US
Mailing Address - Phone:240-550-2528
Mailing Address - Fax:
Practice Address - Street 1:11628 LOCKWOOD DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2330
Practice Address - Country:US
Practice Address - Phone:240-550-2528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD374U00000X374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide