Provider Demographics
NPI:1710218896
Name:BAWUAH-EDUSEI, KWAME (MD)
Entity Type:Individual
Prefix:DR
First Name:KWAME
Middle Name:
Last Name:BAWUAH-EDUSEI
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 1:4405 HILLSIDE CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:23306
Mailing Address - Country:US
Mailing Address - Phone:301-661-7103
Mailing Address - Fax:
Practice Address - Street 1:4405 HILLSIDE CT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-1215
Practice Address - Country:US
Practice Address - Phone:301-661-7103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-29
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA0101233498207R00000X
DCMD21917207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine