Healthcare Provider Details

I. General information

NPI: 1982948212
Provider Name (Legal Business Name): TABE JOHNTANYI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2012
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 HUNT PL NE
WASHINGTON DC
20019-3565
US

IV. Provider business mailing address

6731 NEW HAMPSHIRE AVE APT 802
TAKOMA PARK MD
20912-2865
US

V. Phone/Fax

Practice location:
  • Phone: 202-388-4300
  • Fax: 202-388-4339
Mailing address:
  • Phone: 240-554-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: