Provider Demographics
NPI:1891014684
Name:AMEYAW, SAMUEL K (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:K
Last Name:AMEYAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SAMUEL
Other - Middle Name:K
Other - Last Name:AMEYAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD CWSP PNS CSA OPA
Mailing Address - Street 1:327 SAINT MARYS AVE APT G
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-5950
Mailing Address - Country:US
Mailing Address - Phone:301-392-3887
Mailing Address - Fax:301-392-3887
Practice Address - Street 1:5 GARRETT AVE
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5960
Practice Address - Country:US
Practice Address - Phone:301-609-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2014-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000191246ZC0007X
MD3020246ZC0007X
MD651855246ZS0410X
133N00000X, 133NN1002X, 174H00000X
MD1180246ZX2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No174H00000XOther Service ProvidersHealth Educator
No246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic Assistant