Provider Demographics
NPI:1396929188
Name:EDWARD AMOAH MD PA
Entity type:Organization
Organization Name:EDWARD AMOAH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:AMOAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-948-5180
Mailing Address - Street 1:PO BOX 47023
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33646-0109
Mailing Address - Country:US
Mailing Address - Phone:813-983-0700
Mailing Address - Fax:
Practice Address - Street 1:27455 CASHFORD CIR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6901
Practice Address - Country:US
Practice Address - Phone:813-948-5810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88213174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268830100Medicaid
FLK5138Medicare PIN
FLG41841Medicare UPIN