Healthcare Provider Details

I. General information

NPI: 1518410398
Provider Name (Legal Business Name): DIDACUS TAMAMBANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2016
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 SAMUEL MORSE DR STE 150
COLUMBIA MD
21046-3420
US

IV. Provider business mailing address

7120 SAMUEL MORSE DR STE 150
COLUMBIA MD
21046-3420
US

V. Phone/Fax

Practice location:
  • Phone: 888-344-5977
  • Fax:
Mailing address:
  • Phone: 888-344-5977
  • Fax: 888-344-5977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: