Provider Demographics
NPI:1730607904
Name:AGBEGNINOU, AKPENE NOVILE
Entity type:Individual
Prefix:
First Name:AKPENE
Middle Name:NOVILE
Last Name:AGBEGNINOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 CARROLL AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5715
Mailing Address - Country:US
Mailing Address - Phone:301-980-8761
Mailing Address - Fax:
Practice Address - Street 1:3934 ANGELTON CT
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-2055
Practice Address - Country:US
Practice Address - Phone:301-980-8761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA3699208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation