Provider Demographics
NPI:1316656291
Name:TCHAKAM, GAUTHIER BETEA
Entity type:Individual
Prefix:
First Name:GAUTHIER
Middle Name:BETEA
Last Name:TCHAKAM
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 1:4416 MEANDERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-2220
Mailing Address - Country:US
Mailing Address - Phone:240-429-2599
Mailing Address - Fax:
Practice Address - Street 1:2759 MLK JR AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2220
Practice Address - Country:US
Practice Address - Phone:202-827-9961
Practice Address - Fax:202-827-9961
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-18
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator