Provider Demographics
NPI:1730440231
Name:DJATANG, DUCLAIR
Entity type:Individual
Prefix:MR
First Name:DUCLAIR
Middle Name:
Last Name:DJATANG
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 1:11215 OAK LEAF DR APT 1515
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1377
Mailing Address - Country:US
Mailing Address - Phone:240-552-4584
Mailing Address - Fax:
Practice Address - Street 1:11215 OAK LEAF DR APT 1515
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1377
Practice Address - Country:US
Practice Address - Phone:240-552-4584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health