Provider Demographics
NPI:1710922901
Name:ASAMOA, GODSON (MD)
Entity Type:Individual
Prefix:
First Name:GODSON
Middle Name:
Last Name:ASAMOA
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 1:7408 W CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-2006
Mailing Address - Country:US
Mailing Address - Phone:610-931-1502
Mailing Address - Fax:610-931-1502
Practice Address - Street 1:7408 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-2006
Practice Address - Country:US
Practice Address - Phone:610-931-1502
Practice Address - Fax:610-931-1502
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072030L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020560440001Medicaid
PA1020560440001Medicaid
PA119675XK8Medicare PIN
NJ081630Medicare ID - Type Unspecified