Provider Demographics
NPI:1811992506
Name:DONKOR, KWABENA A (MD,FCCPMPH&TM)
Entity type:Individual
Prefix:DR
First Name:KWABENA
Middle Name:A
Last Name:DONKOR
Suffix:
Gender:M
Credentials:MD,FCCPMPH&TM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 353
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-0353
Mailing Address - Country:US
Mailing Address - Phone:434-392-7859
Mailing Address - Fax:434-315-8851
Practice Address - Street 1:800 OAK ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1199
Practice Address - Country:US
Practice Address - Phone:434-392-7859
Practice Address - Fax:434-318-8851
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2016-02-22
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
VA0101047394207RP1001X, 207RS0012X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA138335OtherANTHEM
VA453211OtherANTHEM
VA010133904Medicaid
VAB60373Medicare UPIN
VA00W124C01Medicare PIN