Provider Demographics
NPI:1164818670
Name:AYEWAH, MARTHA EBAIDE PREMOBOERE (DO)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:EBAIDE PREMOBOERE
Last Name:AYEWAH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:433 W 54TH ST APT 18
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-4478
Mailing Address - Country:US
Mailing Address - Phone:254-495-4444
Mailing Address - Fax:
Practice Address - Street 1:1802 BAYBERRY CT STE 300
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3773
Practice Address - Country:US
Practice Address - Phone:804-212-3042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY305579208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery