Provider Demographics
NPI:1992201891
Name:LOPEZ-TWUMASI, MOSES KWASI
Entity Type:Individual
Prefix:
First Name:MOSES
Middle Name:KWASI
Last Name:LOPEZ-TWUMASI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MOSES
Other - Middle Name:KWASI
Other - Last Name:TWUMASI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2416 CYPRESS GREEN LN
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-5349
Mailing Address - Country:US
Mailing Address - Phone:480-254-6472
Mailing Address - Fax:
Practice Address - Street 1:1906 BELLEVIEW AVE SE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1838
Practice Address - Country:US
Practice Address - Phone:540-981-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-01
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA390200000X261QS1000X
VA0101271600207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health