Provider Demographics
NPI:1710989074
Name:AKOSAH, KWAME O (MD)
Entity Type:Individual
Prefix:
First Name:KWAME
Middle Name:O
Last Name:AKOSAH
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:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 SUNSET LN
Practice Address - Street 2:1ST FLOOR, ROOM 1108
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3917
Practice Address - Country:US
Practice Address - Phone:540-829-4400
Practice Address - Fax:540-829-5001
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043561207RC0000X
PAMD444415207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0074732Medicaid
WV3810006639Medicaid
PA1026617800001Medicaid
WI32394700Medicaid
WI32394700Medicaid
E56116Medicare UPIN
WV3810006639Medicaid