Provider Demographics
NPI:1265023808
Name:MASSENBURG, ANQUAN
Entity Type:Individual
Prefix:MR
First Name:ANQUAN
Middle Name:
Last Name:MASSENBURG
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 1:514 DANIELS ST STE 193
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1317
Mailing Address - Country:US
Mailing Address - Phone:984-867-7347
Mailing Address - Fax:
Practice Address - Street 1:1108 COLEMAN ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-3860
Practice Address - Country:US
Practice Address - Phone:984-867-7347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker