Healthcare Provider Details

I. General information

NPI: 1457297194
Provider Name (Legal Business Name): EDDIE KOMI AFETSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: EDDIE ETONAM KOMI AFETSE BAH MD

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

210 S 12TH ST APT 25C
PHILADELPHIA PA
19107-6335
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-6861
  • Fax:
Mailing address:
  • Phone: 704-904-8749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberAPPLIED
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: