Provider Demographics
NPI:1629848783
Name:BONSU, KWAME
Entity Type:Individual
Prefix:
First Name:KWAME
Middle Name:
Last Name:BONSU
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 1:24 CRYSTAL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01108-1722
Mailing Address - Country:US
Mailing Address - Phone:413-406-8387
Mailing Address - Fax:
Practice Address - Street 1:276 BRIDGE ST STE 305
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1410
Practice Address - Country:US
Practice Address - Phone:413-406-8387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver