Provider Demographics
NPI:1164699310
Name:ADU-SARKODIE, NANA YAW AMPAW (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:NANA YAW
Middle Name:AMPAW
Last Name:ADU-SARKODIE
Suffix:
Gender:M
Credentials:MD, MPH
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Mailing Address - Street 1:3900 LOCH RAVEN BLVD
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2108
Mailing Address - Country:US
Mailing Address - Phone:410-605-7620
Mailing Address - Fax:410-605-7676
Practice Address - Street 1:4924 CAMPBELL BLVD
Practice Address - Street 2:SUITE 125
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-5908
Practice Address - Country:US
Practice Address - Phone:443-461-1997
Practice Address - Fax:443-461-1998
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2016-08-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.204607207Q00000X
MDD0074827207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD149619Medicare PIN
MD945LMedicare PIN
MD325471Medicare PIN