Provider Demographics
NPI:1598520132
Name:AGYEMAN, KOFI
Entity Type:Individual
Prefix:
First Name:KOFI
Middle Name:
Last Name:AGYEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 TRAVELER ST APT 703
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2967
Mailing Address - Country:US
Mailing Address - Phone:443-851-9192
Mailing Address - Fax:
Practice Address - Street 1:55 TRAVELER ST APT 703
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2967
Practice Address - Country:US
Practice Address - Phone:443-851-9192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program