Provider Demographics
NPI:1780712968
Name:NEEQUAYE, FRED EZEKIEL (PA-C)
Entity type:Individual
Prefix:MR
First Name:FRED
Middle Name:EZEKIEL
Last Name:NEEQUAYE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:13616 JAMIESON PL
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1475
Mailing Address - Country:US
Mailing Address - Phone:240-997-6986
Mailing Address - Fax:
Practice Address - Street 1:7411 RIGGS RD
Practice Address - Street 2:SUITE 404
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-4246
Practice Address - Country:US
Practice Address - Phone:301-445-0600
Practice Address - Fax:301-445-1516
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0002742363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical