Provider Demographics
NPI:1558332833
Name:OWUSU-ADDO, YAW ADJEI (MD)
Entity Type:Individual
Prefix:DR
First Name:YAW
Middle Name:ADJEI
Last Name:OWUSU-ADDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:640 SUMMIT CROSSING PL
Mailing Address - Street 2:STE 240
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2138
Mailing Address - Country:US
Mailing Address - Phone:704-865-0626
Mailing Address - Fax:704-865-6531
Practice Address - Street 1:640 SUMMIT CROSSING PL
Practice Address - Street 2:STE 204
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2138
Practice Address - Country:US
Practice Address - Phone:704-865-0626
Practice Address - Fax:704-865-6531
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9500419208000000X, 2084A0401X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8964704Medicaid
NCF87747Medicare UPIN
NC2208460HMedicare PIN