Healthcare Provider Details

I. General information

NPI: 1477496677
Provider Name (Legal Business Name): FRED AGAK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FREDRICK AGAK

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19544 MONTGOMERY VILLAGE AVE
GAITHERSBURG MD
20886-1917
US

IV. Provider business mailing address

19544 MONTGOMERY VILLAGE AVE
GAITHERSBURG MD
20886-1917
US

V. Phone/Fax

Practice location:
  • Phone: 202-600-1450
  • Fax:
Mailing address:
  • Phone: 202-600-1450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: