MEDICARE: ENOCH AGYEMANG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	A673299991	VA

General Provider Information

NPI Number	:	1548890304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENOCH AGYEMANG

Provider Business Mailing Address
First Line	:	146 SHORT BRANCH RD
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22556-4642
Country	:	US
Telephone Number	:	678-651-9336
Fax Number	:

Provider Business Practice Location Address
First Line	:	146 SHORT BRANCH RD
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22556-4642
Country	:	US
Telephone Number	:	678-651-9336
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2020
Last Update Date	:	01/21/2020

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Directions to “ ENOCH AGYEMANG ” Practice Location

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