Provider Demographics
NPI:1215580816
Name:OWUSU, KWABENA
Entity Type:Individual
Prefix:
First Name:KWABENA
Middle Name:
Last Name:OWUSU
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 1:205 E JOPPA RD STE 106
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-3203
Mailing Address - Country:US
Mailing Address - Phone:410-337-0007
Mailing Address - Fax:
Practice Address - Street 1:205 E JOPPA RD STE 106
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3203
Practice Address - Country:US
Practice Address - Phone:410-337-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR1997602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty