Provider Demographics
NPI:1427868009
Name:ENGRAM, ANTAWANS TREMAYNE (MEDICAL TRANSIT)
Entity type:Individual
Prefix:
First Name:ANTAWANS
Middle Name:TREMAYNE
Last Name:ENGRAM
Suffix:
Gender:M
Credentials:MEDICAL TRANSIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5785 HENDERSON LN
Mailing Address - Street 2:
Mailing Address - City:COVESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22931-1826
Mailing Address - Country:US
Mailing Address - Phone:434-437-1752
Mailing Address - Fax:
Practice Address - Street 1:5785 HENDERSON LN
Practice Address - Street 2:
Practice Address - City:COVESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22931-1826
Practice Address - Country:US
Practice Address - Phone:856-952-0602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)