Provider Demographics
NPI:1881668937
Name:OTCHERE-BOATENG, YAW (MD)
Entity type:Individual
Prefix:
First Name:YAW
Middle Name:
Last Name:OTCHERE-BOATENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:YAW
Other - Middle Name:
Other - Last Name:OTCHERE-BOATENG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1005 CARRINGTON CT
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-5694
Mailing Address - Country:US
Mailing Address - Phone:236-777-0404
Mailing Address - Fax:
Practice Address - Street 1:1627 QUARRIER ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-2124
Practice Address - Country:US
Practice Address - Phone:757-536-2246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
TN40708207P00000X, 207R00000X, 208M00000X
VA0101242839207R00000X
TNFO3926663207RA0401X
KY43217208M00000X
WV29872207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNI47997Medicare UPIN