Provider Demographics
NPI:1831772581
Name:TEMBEG, BILLY MBAH
Entity type:Individual
Prefix:
First Name:BILLY
Middle Name:MBAH
Last Name:TEMBEG
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 1:11102 MAIDEN DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3586
Mailing Address - Country:US
Mailing Address - Phone:240-527-3564
Mailing Address - Fax:
Practice Address - Street 1:11102 MAIDEN DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-3586
Practice Address - Country:US
Practice Address - Phone:240-527-3564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376K00000X
DCHHA200001729374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide