Provider Demographics
NPI:1417510967
Name:BEN, DORIS AKUDAZIE (NP-BC)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:AKUDAZIE
Last Name:BEN
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5721 RITCHIE HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:MD
Mailing Address - Zip Code:21225-3640
Mailing Address - Country:US
Mailing Address - Phone:410-206-3839
Mailing Address - Fax:410-401-0102
Practice Address - Street 1:5721 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:MD
Practice Address - Zip Code:21225-3640
Practice Address - Country:US
Practice Address - Phone:585-415-1942
Practice Address - Fax:410-401-0102
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR167482363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE