Provider Demographics
NPI:1194246611
Name:TAAH, PEKLINS BUMA
Entity type:Individual
Prefix:
First Name:PEKLINS
Middle Name:BUMA
Last Name:TAAH
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 1:9125 SPRINGHILL LN
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1219
Mailing Address - Country:US
Mailing Address - Phone:443-968-6652
Mailing Address - Fax:
Practice Address - Street 1:9125 SPRINGHILLS LANE APT 204 GREENBELT MD
Practice Address - Street 2:
Practice Address - City:GREENBELT MD
Practice Address - State:MD
Practice Address - Zip Code:20770
Practice Address - Country:US
Practice Address - Phone:443-968-6652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC171M00000X
DCHHA12826374U00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide