Provider Demographics
NPI:1336122787
Name:OWUSU-BOAITEY, KOFI (MD)
Entity Type:Individual
Prefix:
First Name:KOFI
Middle Name:
Last Name:OWUSU-BOAITEY
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:PO BOX 64485
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4485
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5803
Practice Address - Country:US
Practice Address - Phone:410-787-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0048006207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5617957OtherCIGNA
MD5227OtherBRAVO/ELDER HEALTH
MD54236602OtherCARE FIRST BLUE CROSS
DCF551-0003OtherCARE FIRST BLUE CROSS
MD200283OtherJOHNS HOPKINS HEALTH CARE
MD3058457OtherAETNA HMO
MD52508OtherAMERIGROUP
MD7866416OtherAETNA PPO
MD7866416OtherAETNA PPO