Provider Demographics
NPI:1528328929
Name:TAJOUGONG, ERIC HERVE YEFOUE
Entity type:Individual
Prefix:
First Name:ERIC HERVE
Middle Name:YEFOUE
Last Name:TAJOUGONG
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 1:8830 PINEY BRANCH ROAD
Mailing Address - Street 2:APT 1101
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903
Mailing Address - Country:US
Mailing Address - Phone:240-406-0708
Mailing Address - Fax:
Practice Address - Street 1:8830 PINEY BRANCH RD
Practice Address - Street 2:APT 1101
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-3546
Practice Address - Country:US
Practice Address - Phone:240-406-0708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD061-159-535374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide