Healthcare Provider Details

I. General information

NPI: 1154688448
Provider Name (Legal Business Name): KOFI-BUAKU ATSINA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2602 BUFORD RD
NORTH CHESTERFIELD VA
23235-3422
US

IV. Provider business mailing address

2602 BUFORD RD
NORTH CHESTERFIELD VA
23235-3422
US

V. Phone/Fax

Practice location:
  • Phone: 804-272-8806
  • Fax: 804-272-2909
Mailing address:
  • Phone: 804-272-8806
  • Fax: 804-272-2909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101271717
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number0101271717
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number0101271717
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: