Healthcare Provider Details

I. General information

NPI: 1003495987
Provider Name (Legal Business Name): FRIMPONG KWABENA KODUA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 CLEMENT AVE
PARKVILLE MD
21234-2603
US

IV. Provider business mailing address

8901 CLEMENT AVE
PARKVILLE MD
21234-2603
US

V. Phone/Fax

Practice location:
  • Phone: 410-661-4670
  • Fax: 410-661-4671
Mailing address:
  • Phone: 410-661-4670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0102208
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: