Provider Demographics
NPI:1063631281
Name:ADZOTOR, KWASI (MD)
Entity Type:Individual
Prefix:DR
First Name:KWASI
Middle Name:
Last Name:ADZOTOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3270 JOE BATTLE BLVD
Mailing Address - Street 2:SUITE 235
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-2639
Mailing Address - Country:US
Mailing Address - Phone:915-504-6890
Mailing Address - Fax:915-849-1712
Practice Address - Street 1:3270 JOE BATTLE BLVD
Practice Address - Street 2:SUITE 235
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-2639
Practice Address - Country:US
Practice Address - Phone:915-504-6890
Practice Address - Fax:915-849-1712
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY222413207R00000X
CAA1020662084N0600X
TXN86022084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH56182Medicare UPIN