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General NPI Number Information
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NPI Number | 1518646645
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Entity Type | Individual
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Provider Name | MICHELLE EKUA SERWAA TWEEDIE PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/17/2023
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 7 GRANITE PL STE 14
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City | GAITHERSBURG
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State | MD
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Zip | 20878-6607
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Country | US
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Telephone | 240-631-1170
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Fax |
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Provider Business Mailing Address
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Address Line | 13 TRUCK HOUSE RD
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City | SEVERNA PARK
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State | MD
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Zip | 21146-2714
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Country | US
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Telephone | 443-824-7729
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0008968
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License Number State | MD
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