Provider Demographics
NPI:1255088969
Name:ADZOH, KOFFI MAWUNYO
Entity type:Individual
Prefix:
First Name:KOFFI
Middle Name:MAWUNYO
Last Name:ADZOH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2904 ALLISON ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1340
Mailing Address - Country:US
Mailing Address - Phone:202-582-9563
Mailing Address - Fax:
Practice Address - Street 1:2904 ALLISON ST
Practice Address - Street 2:
Practice Address - City:MOUNT RAINIER
Practice Address - State:MD
Practice Address - Zip Code:20712-1340
Practice Address - Country:US
Practice Address - Phone:202-582-9563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide