Provider Demographics
NPI:1336767227
Name:BOAKAI, MERLYN ANGELLA
Entity Type:Individual
Prefix:
First Name:MERLYN
Middle Name:ANGELLA
Last Name:BOAKAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 SERO PINE LN
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-5954
Mailing Address - Country:US
Mailing Address - Phone:301-257-8395
Mailing Address - Fax:
Practice Address - Street 1:800 SERO PINE LN
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-5954
Practice Address - Country:US
Practice Address - Phone:510-368-4238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC121363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical