Healthcare Provider Details

I. General information

NPI: 1023360351
Provider Name (Legal Business Name): BERTRAND TAGHEU M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9777 GOOD LUCK RD APT 6
LANHAM MD
20706-3337
US

IV. Provider business mailing address

9777 GOOD LUCK RD APT 6
LANHAM MD
20706-3337
US

V. Phone/Fax

Practice location:
  • Phone: 240-441-3892
  • Fax:
Mailing address:
  • Phone: 240-441-3892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number39200000X
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: