Healthcare Provider Details

I. General information

NPI: 1881599082
Provider Name (Legal Business Name): MDBUABENG HEALTH FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7423 PICARDY AVE STE D
BATON ROUGE LA
70808-4362
US

IV. Provider business mailing address

11719 SILO DR
BATON ROUGE LA
70810-2284
US

V. Phone/Fax

Practice location:
  • Phone: 225-960-2630
  • Fax: 225-256-4488
Mailing address:
  • Phone: 225-960-2630
  • Fax: 225-256-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: KWAME BUABENG
Title or Position: OWNER
Credential: MD
Phone: 225-960-2630