Healthcare Provider Details

I. General information

NPI: 1316387673
Provider Name (Legal Business Name): KWAME BUABENG MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 10/25/2021
Certification Date: 08/24/2021
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

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

V. Phone/Fax

Practice location:
  • Phone: 757-373-3551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number305542
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA150969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: