Healthcare Provider Details

I. General information

NPI: 1245165679
Provider Name (Legal Business Name): KWABENA AMO ASARE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GEORGETOWN UNIVERSITY
WASHINGTON DC
20057-0001
US

IV. Provider business mailing address

115 GRATIOT DR
MORRISVILLE NC
27560-7713
US

V. Phone/Fax

Practice location:
  • Phone: 202-687-0100
  • Fax:
Mailing address:
  • Phone: 347-479-5567
  • Fax: 347-479-5567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number324144
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: