1629369301 NPI number — MR. KYERETWIE FRIMPONG BOSOMTWE CRNP

Table of content: MR. KYERETWIE FRIMPONG BOSOMTWE CRNP (NPI 1629369301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629369301 NPI number — MR. KYERETWIE FRIMPONG BOSOMTWE CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOSOMTWE
Provider First Name:
KYERETWIE
Provider Middle Name:
FRIMPONG
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
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:
1629369301
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6901 PAMELA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20735-3332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-602-7897
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4000 MITCHELLVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 422
Provider Business Practice Location Address City Name:
BOWIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20716-3104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-809-6206
Provider Business Practice Location Address Fax Number:
301-809-6225
Provider Enumeration Date:
04/28/2011

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: 363LA2200X , with the licence number:  R167843 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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