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General NPI Number Information
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NPI Number | 1588462097
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Entity Type | Individual
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Provider Name | MR. GEORGE MUSTAPHA MASSAQUOI
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Gender | Male
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Dates
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Enumeration Date | 03/03/2025
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 10201 PEMBROOKE GREEN PL#78 PL#78
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City | COLUMBIA
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State | MD
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Zip | 21044-2104
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Country | US
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Telephone | 201-989-7716
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Fax | 202-516-4995
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Provider Business Mailing Address
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Address Line | 10201 PEMBROOKE GREEN PL#78 PL #78
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City | COLUMBIA
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State | MD
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Zip | 21044
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Country | US
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Telephone | 201-989-7716
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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