Provider Demographics
NPI:1659558021
Name:ANYAGAFU, CHARLTON C
Entity Type:Individual
Prefix:
First Name:CHARLTON
Middle Name:C
Last Name:ANYAGAFU
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 1:2620 TANGLEWILDE ST STE 109
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-3203
Mailing Address - Country:US
Mailing Address - Phone:346-261-2083
Mailing Address - Fax:346-341-3344
Practice Address - Street 1:2620 TANGLEWILDE ST STE 109
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-3203
Practice Address - Country:US
Practice Address - Phone:346-261-2083
Practice Address - Fax:346-341-3344
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009927251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679544Medicare Oscar/Certification