1235877945 NPI number — MR. AMOAFO DWUMFOUR BOAMPONG MD

Table of content: MR. AMOAFO DWUMFOUR BOAMPONG MD (NPI 1235877945)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235877945 NPI number — MR. AMOAFO DWUMFOUR BOAMPONG MD

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
BOAMPONG

Provider First Name:
AMOAFO

Provider Middle Name:
DWUMFOUR

Provider Name Prefix Text:
MR.

Provider Name Suffix Text:

Provider Credential Text:
MD

Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235877945

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
03/07/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:
02/20/2023

NPI Reactivation Date:
03/01/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1110 FIDLER LANE

Provider Second Line Business Mailing Address:
APT # 1505

Provider Business Mailing Address City Name:
SILVER SPRING

Provider Business Mailing Address State Name:
MD

Provider Business Mailing Address Postal Code:
20910

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
240-936-8424

Provider Business Mailing Address Fax Number:
202-865-1773

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2041 GEORGIA AVENUE, NW HOWARD UNIVERSITY HOSPITAL,

Provider Second Line Business Practice Location Address:
SUITE 2039

Provider Business Practice Location Address City Name:
WASHINGTON

Provider Business Practice Location Address State Name:
DC

Provider Business Practice Location Address Postal Code:
20060

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
202-689-5399

Provider Business Practice Location Address Fax Number:
202-865-1773

Provider Enumeration Date:
05/23/2022

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Taxonomy code: 390200000X , with the licence number: MTL600001600 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .