Provider Demographics
NPI:1508806456
Name:AGYEMAN, KWABENA OSEI (MD)
Entity Type:Individual
Prefix:
First Name:KWABENA
Middle Name:OSEI
Last Name:AGYEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:GREGORY
Other - Middle Name:DELEON
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2731 S CRATER RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-2403
Mailing Address - Country:US
Mailing Address - Phone:804-520-1080
Mailing Address - Fax:804-520-1906
Practice Address - Street 1:2731 S CRATER RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-2403
Practice Address - Country:US
Practice Address - Phone:804-520-1080
Practice Address - Fax:804-520-1906
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233334207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH86947Medicare UPIN
VAVV8519A282Medicare PIN