Provider Demographics
NPI:1093094146
Name:AGONAFIR, MICHAEL MENGESHA (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MENGESHA
Last Name:AGONAFIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11303 AMHERST AVE.
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902
Mailing Address - Country:US
Mailing Address - Phone:240-833-8014
Mailing Address - Fax:240-833-8047
Practice Address - Street 1:11303 AMHERST AVE.
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902
Practice Address - Country:US
Practice Address - Phone:240-833-8014
Practice Address - Fax:240-833-8047
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD72842207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine