MEDICARE: DR. EDWARD KWODWO BOAKYE 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	207R00000X	Internal Medicine Physician	0101057406	VA

General Provider Information

NPI Number	:	1477544914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD KWODWO BOAKYE MD

Provider Business Mailing Address
First Line	:	PO BOX 2078
Second Line	:
City	:	PRINCE GEORGE
State	:	VA
Zip	:	23875-1998
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12407 INVERNESS WAY
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23836-8629
Country	:	US
Telephone Number	:	703-768-9660
Fax Number	:

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

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	05/23/2020

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