Provider Demographics
NPI:1073050316
Name:OTCHERE, KWADWO MANU
Entity Type:Individual
Prefix:MR
First Name:KWADWO
Middle Name:MANU
Last Name:OTCHERE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5296 PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-4033
Mailing Address - Country:US
Mailing Address - Phone:614-747-1521
Mailing Address - Fax:
Practice Address - Street 1:5150 EAST MAIN ST
Practice Address - Street 2:SUIT 105
Practice Address - City:WHITEHALL
Practice Address - State:OH
Practice Address - Zip Code:43213-2441
Practice Address - Country:US
Practice Address - Phone:614-359-2301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF1116618363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care