Provider Demographics
NPI:1992682421
Name:PROCTOR, TYRONE
Entity type:Individual
Prefix:
First Name:TYRONE
Middle Name:
Last Name:PROCTOR
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 1:30 UPPER ROCK CIR APT 124
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4460
Mailing Address - Country:US
Mailing Address - Phone:202-738-8679
Mailing Address - Fax:
Practice Address - Street 1:2723 SHIPLEY TER SE APT 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-1821
Practice Address - Country:US
Practice Address - Phone:202-738-8679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant