Healthcare Provider Details

I. General information

NPI: 1740990274
Provider Name (Legal Business Name): ERIC TEGWI TEGWI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5908 KING ARTHUR WAY
GLENN DALE MD
20769-8908
US

IV. Provider business mailing address

9767 GOOD LUCK RD APT 9
LANHAM MD
20706-3332
US

V. Phone/Fax

Practice location:
  • Phone: 240-584-1628
  • Fax:
Mailing address:
  • Phone: 240-584-1628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200002642
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: