Provider Demographics
NPI:1952885550
Name:TATAW, TABE NDAKOR
Entity Type:Individual
Prefix:
First Name:TABE
Middle Name:NDAKOR
Last Name:TATAW
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 1:5610 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1153
Mailing Address - Country:US
Mailing Address - Phone:301-665-0186
Mailing Address - Fax:
Practice Address - Street 1:5610 MONROE ST
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-1153
Practice Address - Country:US
Practice Address - Phone:301-665-0186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC13989374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide