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NPI Code Detail

MEDICARE: TRACEY AJOH TEBO

MEDICARE:   TRACEY AJOH TEBO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1374U00000XHome Health Aide

General Provider Information

NPI Number : 1972346070
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACEY AJOH TEBO
Provider Business Mailing Address
First Line : 1707 ARCOLA AVE
Second Line :
City : SILVER SPRING
State : MD
Zip : 20902-2813
Country : US
Telephone Number : 240-481-2256
Fax Number :
Provider Business Practice Location Address
First Line : 1707 ARCOLA AVE
Second Line :
City : SILVER SPRING
State : MD
Zip : 20902-2813
Country : US
Telephone Number : 240-481-2256
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2024
Last Update Date : 06/17/2024

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Directions to “ TRACEY AJOH TEBO ” Practice Location

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