Provider Demographics
NPI:1326845132
Name:TAMBI, GANA RAYMOND
Entity type:Individual
Prefix:
First Name:GANA
Middle Name:RAYMOND
Last Name:TAMBI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8807 BOVELDER DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3524
Mailing Address - Country:US
Mailing Address - Phone:410-504-3040
Mailing Address - Fax:
Practice Address - Street 1:8807 BOVELDER DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3524
Practice Address - Country:US
Practice Address - Phone:410-504-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator