Provider Demographics
NPI:1003814807
Name:NTOSO, KWABENA ADU (MD)
Entity Type:Individual
Prefix:
First Name:KWABENA
Middle Name:ADU
Last Name:NTOSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 W WASHINGTON SQ
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3500
Mailing Address - Country:US
Mailing Address - Phone:215-829-8420
Mailing Address - Fax:215-829-8418
Practice Address - Street 1:230 W WASHINGTON SQ
Practice Address - Street 2:SUITE 100
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3500
Practice Address - Country:US
Practice Address - Phone:215-829-8420
Practice Address - Fax:215-829-8418
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA033220E207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0000113314605Medicaid
0000407311OtherBLUE CROSS/BLUE SHIELD
407311Medicare ID - Type Unspecified
0000407311OtherBLUE CROSS/BLUE SHIELD