Provider Demographics
NPI:1255180956
Name:AGWE, PETER TAMBA JUNIOR
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:TAMBA JUNIOR
Last Name:AGWE
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 1:5303 WHITFIELD CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1905
Mailing Address - Country:US
Mailing Address - Phone:227-205-8813
Mailing Address - Fax:
Practice Address - Street 1:5303 WHITFIELD CHAPEL RD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-1905
Practice Address - Country:US
Practice Address - Phone:227-205-8813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator