Healthcare Provider Details

I. General information

NPI: 1891014684
Provider Name (Legal Business Name): SAMUEL K AMEYAW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SAMUEL K AMEYAW MD CWSP PNS CSA OPA

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 11/02/2025
Certification Date: 11/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 GARRETT AVE
LA PLATA MD
20646-5960
US

IV. Provider business mailing address

327 SAINT MARYS AVE APT E
LA PLATA MD
20646-5961
US

V. Phone/Fax

Practice location:
  • Phone: 301-609-4000
  • Fax:
Mailing address:
  • Phone: 301-247-5990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number3020
License Number State
# 3
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number3020
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberCWSP3858
License Number State
# 5
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number651855
License Number StateMD
# 7
Primary TaxonomyN
Taxonomy Code246ZX2200X
TaxonomyOrthopedic Assistant
License Number1180
License Number State
# 8
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number170048
License Number State
# 10
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number238.000191
License Number StateIL
# 11
Primary TaxonomyN
Taxonomy Code246ZX2200X
TaxonomyOrthopedic Assistant
License Number1180
License Number StateMD
# 12
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPNS2100372R
License Number State
# 13
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberCPH23172
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: