Provider Demographics
NPI:1902622780
Name:MCCARTHUR, TAMYA
Entity type:Individual
Prefix:
First Name:TAMYA
Middle Name:
Last Name:MCCARTHUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 SOUTHERN AVE SE, TEMPLE HILLS, MD 20748
Mailing Address - Street 2:104
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20748
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2607 SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1063
Practice Address - Country:US
Practice Address - Phone:240-536-5477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC53126803747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant