Provider Demographics
NPI:1962646596
Name:AMOAH, NANA OSEI (MD, FACP)
Entity Type:Individual
Prefix:DR
First Name:NANA
Middle Name:OSEI
Last Name:AMOAH
Suffix:
Gender:M
Credentials:MD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6715 LITTLE RIVER TPKE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3546
Mailing Address - Country:US
Mailing Address - Phone:703-942-7339
Mailing Address - Fax:703-942-7448
Practice Address - Street 1:6715 LITTLE RIVER TPKE
Practice Address - Street 2:SUITE 205
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3546
Practice Address - Country:US
Practice Address - Phone:703-942-7339
Practice Address - Fax:703-942-7448
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101245529207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1962646596Medicaid
174653Medicare UPIN
VAVV2233BMedicare PIN