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General NPI Number Information
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NPI Number | 1265023808
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Entity Type | Individual
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Provider Name | MR. ANQUAN MASSENBURG
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Gender | Male
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Dates
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Enumeration Date | 01/27/2021
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Last Update Date | 02/02/2021
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Provider Practice Location Address
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Address Line | 1108 COLEMAN ST
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City | RALEIGH
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State | NC
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Zip | 27610-3860
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Country | US
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Telephone | 984-867-7347
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Fax |
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Provider Business Mailing Address
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Address Line | 514 DANIELS ST STE 193
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City | RALEIGH
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State | NC
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Zip | 27605-1317
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Country | US
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Telephone | 984-867-7347
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number |
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License Number State |
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