Provider Demographics
NPI:1366123796
Name:TAGNE OUABO, CALVIN
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:
Last Name:TAGNE OUABO
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 1:10328 BROOM LN
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2132
Mailing Address - Country:US
Mailing Address - Phone:240-241-2690
Mailing Address - Fax:
Practice Address - Street 1:10328 BROOM LN
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2132
Practice Address - Country:US
Practice Address - Phone:240-241-2690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator