Provider Demographics
NPI:1497738041
Name:ADDO, SAMUEL BOI (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:BOI
Last Name:ADDO
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 MARGUERITE CT
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-3817
Mailing Address - Country:US
Mailing Address - Phone:607-723-2393
Mailing Address - Fax:
Practice Address - Street 1:269 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2726
Practice Address - Country:US
Practice Address - Phone:607-729-9327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209908208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics