Provider Demographics
NPI:1528322443
Name:TINKU, PAVEL TINKU
Entity type:Individual
Prefix:
First Name:PAVEL
Middle Name:TINKU
Last Name:TINKU
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 1:5802 ANNAPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-2075
Mailing Address - Country:US
Mailing Address - Phone:302-358-7154
Mailing Address - Fax:
Practice Address - Street 1:5802 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-2075
Practice Address - Country:US
Practice Address - Phone:302-358-7154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide