Healthcare Provider Details

I. General information

NPI: 1174225353
Provider Name (Legal Business Name): AUDREY ACHIAA BOADU M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 ROEDER RD # 100B
SILVER SPRING MD
20910-4405
US

IV. Provider business mailing address

1750 SEDGWICK AVE APT 18H
BRONX NY
10453-6617
US

V. Phone/Fax

Practice location:
  • Phone: 301-593-7792
  • Fax:
Mailing address:
  • Phone: 347-200-1251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0107299
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: