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NPI Code Detail

MEDICARE: EDDIE KOMI AFETSE MD

MEDICARE: EDDIE KOMI AFETSE 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
1208600000XSurgery PhysicianAPPLIEDMA

General Provider Information

NPI Number : 1457297194
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDDIE KOMI AFETSE MD
Provider Business Mailing Address
First Line : 210 S 12TH ST APT 25C
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19107-6335
Country : US
Telephone Number : 704-904-8749
Fax Number :
Provider Business Practice Location Address
First Line : 75 FRANCIS ST
Second Line :
City : BOSTON
State : MA
Zip : 02115-6110
Country : US
Telephone Number : 617-732-6861
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2026
Last Update Date : 04/27/2026

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Directions to “ EDDIE KOMI AFETSE MD” Practice Location

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