Provider Demographics
NPI:1891126124
Name:TABI, ELVIS AGBORTABI
Entity type:Individual
Prefix:
First Name:ELVIS
Middle Name:AGBORTABI
Last Name:TABI
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 1:9907 GOOD LUCK RD
Mailing Address - Street 2:APT. 201
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3247
Mailing Address - Country:US
Mailing Address - Phone:240-467-1862
Mailing Address - Fax:
Practice Address - Street 1:9907 GOOD LUCK RD
Practice Address - Street 2:APT. 201
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3247
Practice Address - Country:US
Practice Address - Phone:240-467-1862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA9863374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide