Provider Demographics
NPI:1124773262
Name:TEBOH, ELVIS
Entity type:Individual
Prefix:
First Name:ELVIS
Middle Name:
Last Name:TEBOH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6606 LOUISE ST
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2175
Mailing Address - Country:US
Mailing Address - Phone:240-743-7736
Mailing Address - Fax:
Practice Address - Street 1:6606 LOUISE ST
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2175
Practice Address - Country:US
Practice Address - Phone:240-743-7736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide