Provider Demographics
NPI:1003092032
Name:BOATENG, MAJOR K (MD)
Entity Type:Individual
Prefix:DR
First Name:MAJOR
Middle Name:K
Last Name:BOATENG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3998 FAIR RIDGE DR
Mailing Address - Street 2:STE 300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2907
Mailing Address - Country:US
Mailing Address - Phone:703-766-9737
Mailing Address - Fax:703-766-9725
Practice Address - Street 1:501 MEDICAL DR
Practice Address - Street 2:HAMPTON ROADS GASTROENTEROLOGY
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6080
Practice Address - Country:US
Practice Address - Phone:757-826-3434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76514207L00000X
VA0101248909207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology