Provider Demographics
NPI:1619980851
Name:MENSAH, SAMUEL KWAME (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:KWAME
Last Name:MENSAH
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 1:58 E KINGSBRIGE RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468
Mailing Address - Country:US
Mailing Address - Phone:718-295-8243
Mailing Address - Fax:718-584-3805
Practice Address - Street 1:58 E KINGSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-7517
Practice Address - Country:US
Practice Address - Phone:718-295-8243
Practice Address - Fax:718-584-3805
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144315207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
74D141OtherEMPIRE
B79225Medicare UPIN