Provider Demographics
NPI:1972858082
Name:AMOAH, NANA YAMFO NKOOM KWESI (MD)
Entity Type:Individual
Prefix:DR
First Name:NANA YAMFO
Middle Name:NKOOM KWESI
Last Name:AMOAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KWESI
Other - Middle Name:NYN
Other - Last Name:AMOAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:1000 E MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-0027
Practice Address - Country:US
Practice Address - Phone:570-808-5770
Practice Address - Fax:570-808-6362
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD476624207R00000X, 207RP1001X, 207RC0200X
CT56092207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400219812Medicare PIN