Provider Demographics
NPI:1336780980
Name:ENNINFUL, JOSEPH SMITH (PRESIDENT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:SMITH
Last Name:ENNINFUL
Suffix:
Gender:M
Credentials:PRESIDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19351 CIRCLE GATE DR APT 204
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-5239
Mailing Address - Country:US
Mailing Address - Phone:240-899-1360
Mailing Address - Fax:240-261-4983
Practice Address - Street 1:19351 CIRCLE GATE DR APT 204
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-5239
Practice Address - Country:US
Practice Address - Phone:240-899-1360
Practice Address - Fax:240-261-4983
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver