Provider Demographics
NPI:1831190354
Name:ANYANE-YEBOA, KWAME (MD)
Entity type:Individual
Prefix:
First Name:KWAME
Middle Name:
Last Name:ANYANE-YEBOA
Suffix:
Gender:M
Credentials:MD
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 95000-2243
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2243
Mailing Address - Country:US
Mailing Address - Phone:845-425-8044
Mailing Address - Fax:845-425-0833
Practice Address - Street 1:1000 10TH AVE
Practice Address - Street 2:SUITE 11A-GENETICS
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1147
Practice Address - Country:US
Practice Address - Phone:212-523-5895
Practice Address - Fax:212-523-3864
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130473-1207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00506827Medicaid
NY39A911Medicare ID - Type Unspecified
NY00506827Medicaid