Provider Demographics
NPI:1992370613
Name:TABRON, DARAK L
Entity Type:Individual
Prefix:MR
First Name:DARAK
Middle Name:L
Last Name:TABRON
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 1:632 46TH PL SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-7822
Mailing Address - Country:US
Mailing Address - Phone:202-365-5953
Mailing Address - Fax:
Practice Address - Street 1:632 46TH PL SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-7822
Practice Address - Country:US
Practice Address - Phone:202-365-5953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider