MEDICARE: PEDRO AGBOR AGBOR ENOH

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1295588408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEDRO AGBOR AGBOR ENOH

Provider Business Mailing Address
First Line	:	354 MONTECRISTO CT
Second Line	:
City	:	SEVERN
State	:	MD
Zip	:	21144-3440
Country	:	US
Telephone Number	:	302-607-4848
Fax Number	:

Provider Business Practice Location Address
First Line	:	354 MONTECRISTO CT
Second Line	:
City	:	SEVERN
State	:	MD
Zip	:	21144-3440
Country	:	US
Telephone Number	:	302-607-4848
Fax Number	:

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

Provider Enumeration Date	:	04/08/2024
Last Update Date	:	04/09/2024

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