Provider Demographics
NPI:1588462097
Name:MASSAQUOI, GEORGE MUSTAPHA
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:MUSTAPHA
Last Name:MASSAQUOI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 PEMBROOKE GREEN PL#78
Mailing Address - Street 2:PL #78
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044
Mailing Address - Country:US
Mailing Address - Phone:201-989-7716
Mailing Address - Fax:
Practice Address - Street 1:10201 PEMBROOKE GREEN PL#78
Practice Address - Street 2:PL#78
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2104
Practice Address - Country:US
Practice Address - Phone:201-989-7716
Practice Address - Fax:202-516-4995
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator