MEDICARE: KWABENA TWENEBOAH KODUAH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1275002529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KWABENA TWENEBOAH KODUAH

Provider Business Mailing Address
First Line	:	2842 FAIRFIELD AVE # APTTB
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-2565
Country	:	US
Telephone Number	:	202-489-7474
Fax Number	:

Provider Business Practice Location Address
First Line	:	9812 FARM POND RD
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20708-6001
Country	:	US
Telephone Number	:	240-535-7209
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2018
Last Update Date	:	07/18/2023

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