Enoch Agyemang

Individual provider Active NPI Emergency Medical Services (Emergency Medicine) Physician · Stafford, VA

NPI 1548890304 · NPPES record last updated Jan 21, 2020

Key facts

NPI
1548890304
Entity type
Individual (NPI type 1)
Primary specialty
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X
License
A673299991 (VA)
Practice address
146 Short Branch Rd
Stafford, VA 22556-4642
Phone
(678) 651-9336
NPI assigned
Jan 21, 2020
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
A673299991VAMDEmergency Medical Services (Emergency Medicine) Physician

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X A673299991 VA Yes

Addresses

Primary practice location

146 Short Branch Rd
Stafford, VA 22556-4642

Mailing address

146 Short Branch Rd
Stafford, VA 22556-4642
Phone (678) 651-9336

Other providers in Stafford, VA

All providers in Stafford, VA · Emergency Medical Services (Emergency Medicine) Physician in Virginia

Sources for this page

Verify at the official NPI Registry.