Healthcare Provider Details

I. General information

NPI: 1053672550
Provider Name (Legal Business Name): GEORGE GYEKE ABOAGYE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2012
Last Update Date: 06/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 NEW YORK AVE NE STE 228
WASHINGTON DC
20002-1851
US

IV. Provider business mailing address

13106 PRINCEVILLE CT
SILVER SPRING MD
20904-3587
US

V. Phone/Fax

Practice location:
  • Phone: 202-832-8340
  • Fax: 202-832-8341
Mailing address:
  • Phone: 301-674-7467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN66144
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: