Provider Demographics
NPI:1205184645
Name:PENTANG, DIDIER LEONARD
Entity type:Individual
Prefix:
First Name:DIDIER
Middle Name:LEONARD
Last Name:PENTANG
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 1:215 ASCOT PL NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1117
Mailing Address - Country:US
Mailing Address - Phone:202-569-0877
Mailing Address - Fax:202-450-3109
Practice Address - Street 1:215 ASCOT PL NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1117
Practice Address - Country:US
Practice Address - Phone:202-569-0877
Practice Address - Fax:202-450-3109
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide