Provider Demographics
NPI:1952974685
Name:TUBBS, SEAN JERMAIN SR
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:JERMAIN
Last Name:TUBBS
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 1:7218 KIPLING PKWY
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-2332
Mailing Address - Country:US
Mailing Address - Phone:202-243-8019
Mailing Address - Fax:
Practice Address - Street 1:7218 KIPLING PKWY
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-2332
Practice Address - Country:US
Practice Address - Phone:202-243-8019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant