Provider Demographics
NPI:1174288393
Name:TCHEAMGAM, THIMOTHEE (HHA)
Entity type:Individual
Prefix:MR
First Name:THIMOTHEE
Middle Name:
Last Name:TCHEAMGAM
Suffix:
Gender:M
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 EDGEWOOD ST NE APT 421
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-3352
Mailing Address - Country:US
Mailing Address - Phone:202-840-3582
Mailing Address - Fax:
Practice Address - Street 1:601 EDGEWOOD ST NE APT 421
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-3352
Practice Address - Country:US
Practice Address - Phone:202-840-3582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 171M00000X
DCHHA14804374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC$$$$$$$$$Medicaid