Healthcare Provider Details

I. General information

NPI: 1881507242
Provider Name (Legal Business Name): AHMAD TATEM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6704 PURPLE LILAC LN
CLINTON MD
20735-4084
US

IV. Provider business mailing address

6704 PURPLE LILAC LN
CLINTON MD
20735-4084
US

V. Phone/Fax

Practice location:
  • Phone: 240-416-0045
  • Fax:
Mailing address:
  • Phone: 240-416-0045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019021098
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: