Provider Demographics
NPI:1225115314
Name:OWUSU, GEORGE EVANS (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:EVANS
Last Name:OWUSU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 GIVAN AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-2924
Mailing Address - Country:US
Mailing Address - Phone:347-449-5936
Mailing Address - Fax:347-449-5937
Practice Address - Street 1:1280 GIVAN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-2924
Practice Address - Country:US
Practice Address - Phone:347-449-5936
Practice Address - Fax:347-449-5937
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232053207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I20130Medicare UPIN