| Doctor Name: | TAHA BOURGO |
| NPI Number: | 1972931285 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | B620785298002 |
| Business Practice Address: | 12450 Independence Ct Apt A5 Princess Anne, MD - 218533022 |
| Business Phone Number: | 4437222111 |
| Business Fax Number: | |
| Mailing Address: | 12450 Independence Ct Apt A5, PRINCESS ANNE |
| State: | MD |
| Postal Code: | 218533022 |
| Phone Number: | 4437222111 |
| Fax Number: | |
| NPI Enumeration Date: | 10/23/2013 |
| NPI Last Update Date: | 10/23/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 344600000X |
| License Number: | B620785298002 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Transportation Services |
| Taxonomy Classification: | Taxi |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A land commercial vehicle used for the transporting of persons in non-emergency situations. The vehicle meets local, county or state regulations set forth by the jurisdictions where it is located. |