Provider Demographics
NPI:1023029790
Name:ADOMFEH, CHARLES NYARKO (MD, PHD, FACP)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:NYARKO
Last Name:ADOMFEH
Suffix:
Gender:M
Credentials:MD, PHD, FACP
Other - Prefix:DR
Other - First Name:CHARLES
Other - Middle Name:
Other - Last Name:NYARKO-ADOMFEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:PO BOX 1048
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-0803
Mailing Address - Country:US
Mailing Address - Phone:518-482-1988
Mailing Address - Fax:518-482-2153
Practice Address - Street 1:523 WESTERN AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-1617
Practice Address - Country:US
Practice Address - Phone:518-482-1988
Practice Address - Fax:518-482-2153
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207948207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY141808104OtherFEDERAL TAX ID
NY01980267Medicaid
NY01980267Medicaid
NYG31506Medicare UPIN