Provider Demographics
NPI:1710336870
Name:OPPONG, CALEB
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:
Last Name:OPPONG
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 1:6404 BUSCH BLVD APT 450
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1821
Mailing Address - Country:US
Mailing Address - Phone:614-632-0895
Mailing Address - Fax:
Practice Address - Street 1:6404 BUSCH BLVD APT 450
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1821
Practice Address - Country:US
Practice Address - Phone:614-632-0895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide