Provider Demographics
NPI:1427690395
Name:AGBOR, SERAPHINE
Entity type:Individual
Prefix:
First Name:SERAPHINE
Middle Name:
Last Name:AGBOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 W WASHINGTON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6688
Mailing Address - Country:US
Mailing Address - Phone:301-247-9039
Mailing Address - Fax:
Practice Address - Street 1:5504 YOUNG FAMILY TRL W
Practice Address - Street 2:
Practice Address - City:ADAMSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21710-8933
Practice Address - Country:US
Practice Address - Phone:301-247-9039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR204852363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health