Provider Demographics
NPI:1831168996
Name:ADJEPONG, YAW AMOATENG (MD)
Entity type:Individual
Prefix:DR
First Name:YAW
Middle Name:AMOATENG
Last Name:ADJEPONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:YAW
Other - Middle Name:
Other - Last Name:AMOATENG-ADJEPONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5246
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-0246
Mailing Address - Country:US
Mailing Address - Phone:203-384-3873
Mailing Address - Fax:203-384-3829
Practice Address - Street 1:226 MILL HILL AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-0246
Practice Address - Country:US
Practice Address - Phone:203-384-3873
Practice Address - Fax:203-384-3829
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036512208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001365122Medicaid
CTG83472Medicare UPIN
CT110007390Medicare ID - Type Unspecified