Provider Demographics
NPI:1952891640
Name:BANGURA, TEJAN W
Entity Type:Individual
Prefix:
First Name:TEJAN
Middle Name:W
Last Name:BANGURA
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 1:5125 SPRING BRANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22025-3046
Mailing Address - Country:US
Mailing Address - Phone:571-888-1824
Mailing Address - Fax:
Practice Address - Street 1:13902 MATHEWS DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-2409
Practice Address - Country:US
Practice Address - Phone:571-888-1824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide