Healthcare Provider Details

I. General information

NPI: 1831168996
Provider Name (Legal Business Name): YAW AMOATENG ADJEPONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DR. YAW AMOATENG-ADJEPONG

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 MILL HILL AVE 3RD FLOOR
BRIDGEPORT CT
06610-0246
US

IV. Provider business mailing address

PO BOX 5246
BRIDGEPORT CT
06610-0246
US

V. Phone/Fax

Practice location:
  • Phone: 203-384-3873
  • Fax: 203-384-3829
Mailing address:
  • Phone: 203-384-3873
  • Fax: 203-384-3829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036512
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036512
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: