MEDICARE: DR. ALEXIUS K BOAKYE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	D0036077	MD

General Provider Information

NPI Number	:	1912985284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXIUS K BOAKYE M.D.

Provider Business Mailing Address
First Line	:	1702 ALBERT TER
Second Line	:
City	:	MITCHELLVILLE
State	:	MD
Zip	:	20721-2202
Country	:	US
Telephone Number	:	301-249-2496
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 W BALTIMORE ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21223-1558
Country	:	US
Telephone Number	:	410-362-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	07/08/2007

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