Provider Demographics
NPI:1508744087
Name:AGNEW, ALFONZO EUGENE
Entity type:Individual
Prefix:MR
First Name:ALFONZO
Middle Name:EUGENE
Last Name:AGNEW
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 1:27600 CHARDON RD APT 375
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44092-2777
Mailing Address - Country:US
Mailing Address - Phone:440-289-3212
Mailing Address - Fax:
Practice Address - Street 1:27600 CHARDON RD APT 375
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44092-2777
Practice Address - Country:US
Practice Address - Phone:440-289-3212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-23
Last Update Date:2025-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver