Provider Demographics
NPI:1649501701
Name:ABOAGYE, BENNET A
Entity type:Individual
Prefix:MR
First Name:BENNET
Middle Name:A
Last Name:ABOAGYE
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 1:14516 SMOKETOWN RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4719
Mailing Address - Country:US
Mailing Address - Phone:703-497-6171
Mailing Address - Fax:703-497-6172
Practice Address - Street 1:14516 SMOKETOWN RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4719
Practice Address - Country:US
Practice Address - Phone:703-497-6171
Practice Address - Fax:703-497-6172
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies