MEDICARE: MR. BAAH ASANTE MD

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	208000000X	Pediatrics Physician	220346	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396746087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BAAH ASANTE MD

Provider Business Mailing Address
First Line	:	3130 GRAND CONCOURSE STE 1K
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-1263
Country	:	US
Telephone Number	:	718-513-3536
Fax Number	:	347-591-0201

Provider Business Practice Location Address
First Line	:	3130 GRAND CONCOURSE STE 1K
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-1263
Country	:	US
Telephone Number	:	718-513-3536
Fax Number	:	347-591-0201

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	11/01/2023

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