Healthcare Provider Details

I. General information

NPI: 1578143012
Provider Name (Legal Business Name): KWABENA GYABAAH OWUSU-ANSAH MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MARKET ST
BOARDMAN OH
44512-6725
US

IV. Provider business mailing address

1001 COVINGTON ST
YOUNGSTOWN OH
44510-1617
US

V. Phone/Fax

Practice location:
  • Phone: 330-480-2616
  • Fax: 330-729-1591
Mailing address:
  • Phone: 330-480-2616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.150241
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: