Provider Demographics
NPI:1205346327
Name:TANGY, CLINTON T
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:T
Last Name:TANGY
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 1:7981 NEW RIGGS RD APT 206
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-4869
Mailing Address - Country:US
Mailing Address - Phone:240-760-9867
Mailing Address - Fax:
Practice Address - Street 1:7981 NEW RIGGS RD APT 206
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-4869
Practice Address - Country:US
Practice Address - Phone:240-760-9867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC13135374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC13135OtherHHA