Provider Demographics
NPI:1124002118
Name:KWOFIE, PETER KENNEDY (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:KENNEDY
Last Name:KWOFIE
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 1:115 EAGLES NEST DR STE B
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-2762
Mailing Address - Country:US
Mailing Address - Phone:864-885-2000
Mailing Address - Fax:
Practice Address - Street 1:115 EAGLES NEST DR
Practice Address - Street 2:SUITE B
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-2762
Practice Address - Country:US
Practice Address - Phone:864-885-2000
Practice Address - Fax:864-885-1004
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21992207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4100Medicaid
SC202232444Medicaid
H35767Medicare UPIN
SCH357678200Medicare ID - Type Unspecified
SCGP4100Medicaid