Provider Demographics
NPI:1922595891
Name:AMANKWAH OWUSU, DOREEN ESTHER (MD)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:ESTHER
Last Name:AMANKWAH OWUSU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DOREEN
Other - Middle Name:ESTHER
Other - Last Name:ABOAGYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:130 MEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1206
Mailing Address - Country:US
Mailing Address - Phone:631-475-5734
Mailing Address - Fax:
Practice Address - Street 1:130 MEDFORD AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1206
Practice Address - Country:US
Practice Address - Phone:631-475-5734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY312122207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program