Healthcare Provider Details

I. General information

NPI: 1841256526
Provider Name (Legal Business Name): DEREK O'KOFI BOAHENE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KOFI DEREK OWUSU BOAHENE M.D.

II. Dates (important events)

Enumeration Date: 04/22/2006
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N CAROLINE ST
BALTIMORE MD
21287-0006
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-1686
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberD63373
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: