Healthcare Provider Details

I. General information

NPI: 1144707787
Provider Name (Legal Business Name): EMMAN-DYLANE TOH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 CRESTLINE RD
SILVER SPRING MD
20904-1431
US

IV. Provider business mailing address

1613 CRESTLINE RD
SILVER SPRING MD
20904-1431
US

V. Phone/Fax

Practice location:
  • Phone: 240-706-0548
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: