MEDICARE: EMMANUEL ANTWI

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	343900000X	Non-emergency Medical Transport (VAN)

Other Identifiers

#	Provider Identifier Type	Provider Identifier Issuer
1	OTHER	000000000000
2	OTHER	0000000000000
3	OTHER	00000000000

General Provider Information

NPI Number	:	1932612710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMANUEL ANTWI

Provider Business Mailing Address
First Line	:	2603 GLENRIVER WAY
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-5178
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2603 GLENRIVER WAY
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-5178
Country	:	US
Telephone Number	:	703-582-4608
Fax Number	:

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

Provider Enumeration Date	:	11/15/2017
Last Update Date	:	06/16/2018

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Directions to “ EMMANUEL ANTWI ” Practice Location

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