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General NPI Number Information
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NPI Number | 1447691001
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Entity Type | Individual
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Provider Name | MARIAMA AMINA MASSAQUOI M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/11/2013
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Last Update Date | 02/06/2019
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Provider Practice Location Address
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Address Line | 1650 COCHRANE CIR
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City | FORT CARSON
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State | CO
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Zip | 80913-4613
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Country | US
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Telephone | 719-396-4896
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 26666 PROVIDER ENROLLMENT
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City | ALBUQUERQUE
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State | NM
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Zip | 87125-6666
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Country | US
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Telephone | 505-923-6770
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Fax | 505-923-5354
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD-17819
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License Number State | HI
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