Healthcare Provider Details

I. General information

NPI: 1861159717
Provider Name (Legal Business Name): DARAMFON REGINA BOFAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2021
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E CHESTNUT ST
AUGUSTA ME
04330-5736
US

IV. Provider business mailing address

15 E CHESTNUT ST
AUGUSTA ME
04330-5736
US

V. Phone/Fax

Practice location:
  • Phone: 207-626-1561
  • Fax: 207-626-1849
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberEC231116
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberEC231116
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberP113133
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: