Basic Information
| Provider Information | |||||||||
| NPI: | 1477849412 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AGONAFER | ||||||||
| FirstName: | SENAYET | ||||||||
| MiddleName: | DEREJE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2616 ERWIN RD | ||||||||
| Address2: | UNIT 2224 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277053843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6822250511 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3001 HANOVER ST | ||||||||
| Address2: | DEPARTMENT OF MEDICINE | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212251233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103503565 | ||||||||
| FaxNumber: | 4103540186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2011 | ||||||||
| LastUpdateDate: | 10/17/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2085R0202X | 285336 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085B0100X | 285336 | NY | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging |
No ID Information.