Provider Demographics
NPI:1568545937
Name:POKU-DANKWAH, CEDRIC (MD)
Entity Type:Individual
Prefix:
First Name:CEDRIC
Middle Name:
Last Name:POKU-DANKWAH
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 1:1160 VARNUM ST NE
Mailing Address - Street 2:SUITE 217
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2107
Mailing Address - Country:US
Mailing Address - Phone:202-529-6147
Mailing Address - Fax:202-529-4218
Practice Address - Street 1:1160 VARNUM ST NE
Practice Address - Street 2:SUITE 217
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2107
Practice Address - Country:US
Practice Address - Phone:202-529-6147
Practice Address - Fax:202-529-4218
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD16481207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B93244Medicare UPIN
085846Medicare ID - Type Unspecified