Provider Demographics
NPI:1033504170
Name:OBENG-OKYERE, PAUL (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:OBENG-OKYERE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 KINGSBOROUGH SQ
Mailing Address - Street 2:STE 100
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5041
Mailing Address - Country:US
Mailing Address - Phone:413-652-8185
Mailing Address - Fax:
Practice Address - Street 1:2115 LEITER RD
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342
Practice Address - Country:US
Practice Address - Phone:937-384-6800
Practice Address - Fax:937-384-6938
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0102207269207RC0000X
OH34.013217207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0285134Medicaid