Healthcare Provider Details

I. General information

NPI: 1417879438
Provider Name (Legal Business Name): DENIFAH CAROLINE BUN-TEJAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 WASHINGTON BLVD
BALTIMORE MD
21230-1701
US

IV. Provider business mailing address

1800 WASHINGTON BLVD
BALTIMORE MD
21230-1701
US

V. Phone/Fax

Practice location:
  • Phone: 410-537-3126
  • Fax:
Mailing address:
  • Phone: 410-537-3126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number1184429342
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: