Healthcare Provider Details

I. General information

NPI: 1992201891
Provider Name (Legal Business Name): MOSES KWASI LOPEZ-TWUMASI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MOSES KWASI TWUMASI

II. Dates (important events)

Enumeration Date: 04/01/2018
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 BELLEVIEW AVE SE
ROANOKE VA
24014-1838
US

IV. Provider business mailing address

2416 CYPRESS GREEN LN
HERNDON VA
20171-5349
US

V. Phone/Fax

Practice location:
  • Phone: 540-981-7000
  • Fax:
Mailing address:
  • Phone: 480-254-6472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number390200000X
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101271600
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: