Provider Demographics
NPI:1457170177
Name:TEBO, TINGWEI CLINTON SR
Entity type:Individual
Prefix:
First Name:TINGWEI
Middle Name:CLINTON
Last Name:TEBO
Suffix:SR
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 1:3905 BLACKBURN LN APT 44
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1247
Mailing Address - Country:US
Mailing Address - Phone:240-659-9669
Mailing Address - Fax:
Practice Address - Street 1:8338 VETERANS HWY
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-2588
Practice Address - Country:US
Practice Address - Phone:410-505-5141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator