Healthcare Provider Details

I. General information

NPI: 1396761912
Provider Name (Legal Business Name): BISMARCK AMOAH-APRAKU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 MAGNOLIA ST
ORANGEBURG SC
29115-1466
US

IV. Provider business mailing address

PO BOX 1806
ORANGEBURG SC
29116-1806
US

V. Phone/Fax

Practice location:
  • Phone: 803-531-6900
  • Fax: 803-531-6907
Mailing address:
  • Phone: 803-531-6900
  • Fax: 803-531-6907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number22055
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: