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General NPI Number Information
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NPI Number | 1578143012
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Entity Type | Individual
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Provider Name | KWABENA GYABAAH OWUSU-ANSAH MD, PHD
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Gender | Male
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Dates
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Enumeration Date | 04/09/2021
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 8401 MARKET ST
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City | BOARDMAN
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State | OH
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Zip | 44512-6725
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Country | US
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Telephone | 330-480-2616
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Fax | 330-729-1591
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Provider Business Mailing Address
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Address Line | 1001 COVINGTON ST
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City | YOUNGSTOWN
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State | OH
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Zip | 44510-1617
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Country | US
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Telephone | 330-480-2616
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35.150241
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License Number State | OH
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