1023029790 NPI number — DR. CHARLES NYARKO ADOMFEH MD, PHD, FACP

Table of content: DR. CHARLES NYARKO ADOMFEH MD, PHD, FACP (NPI 1023029790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023029790 NPI number — DR. CHARLES NYARKO ADOMFEH MD, PHD, FACP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADOMFEH
Provider First Name:
CHARLES
Provider Middle Name:
NYARKO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, PHD, FACP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NYARKO-ADOMFEH
Provider Other First Name:
CHARLES
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD, PHD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023029790
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1048
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLIFTON PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12065-0803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-482-1988
Provider Business Mailing Address Fax Number:
518-482-2153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
523 WESTERN AVE
Provider Second Line Business Practice Location Address:
SECOND FLOOR
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12203-1617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-482-1988
Provider Business Practice Location Address Fax Number:
518-482-2153
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  207948 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 141808104 . This is a "FEDERAL TAX ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01980267 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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