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General NPI Number Information
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NPI Number | 1942501234
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Entity Type | Individual
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Provider Name | PAA-KOFI BENIAKO OBENG D.O.
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Gender | Male
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Dates
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Enumeration Date | 11/03/2010
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Last Update Date | 10/24/2019
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Provider Practice Location Address
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Address Line | 827 DILIGENCE DR STE 206
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4268
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Country | US
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Telephone | 757-612-4408
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Fax |
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Provider Business Mailing Address
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Address Line | 827 DILIGENCE DR STE 206
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4268
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Country | US
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Telephone | 757-612-4408
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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 | 0102203549
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License Number State | VA
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