Provider Demographics
NPI:1255857710
Name:AGADA, PETER O
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:O
Last Name:AGADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9215 ISPAHAN LOOP
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2876
Mailing Address - Country:US
Mailing Address - Phone:202-258-7954
Mailing Address - Fax:
Practice Address - Street 1:9215 ISPAHAN LOOP
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-2876
Practice Address - Country:US
Practice Address - Phone:202-258-7954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant