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General NPI Number Information
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NPI Number | 1710218896
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Entity Type | Individual
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Provider Name | KWAME BAWUAH-EDUSEI MD
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Gender | Male
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Dates
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Enumeration Date | 01/29/2010
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Last Update Date | 03/18/2010
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Provider Practice Location Address
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Address Line | 4405 HILLSIDE CT
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City | ALEXANDRIA
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State | VA
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Zip | 22306-1215
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Country | US
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Telephone | 301-661-7103
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Fax |
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Provider Business Mailing Address
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Address Line | 4405 HILLSIDE CT
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City | ALEXANDRIA
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State | VA
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Zip | 23306
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Country | US
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Telephone | 301-661-7103
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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 | VA0101233498
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD21917
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License Number State | DC
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