MEDICARE: YAW OWUSU-POKU PA-C

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	363A00000X	Physician Assistant	C05351	MD

General Provider Information

NPI Number	:	1487066726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAW OWUSU-POKU PA-C

Provider Business Mailing Address
First Line	:	5407 FALLRIVER ROW CT
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-2211
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5407 FALLRIVER ROW CT
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-2211
Country	:	US
Telephone Number	:	443-760-6842
Fax Number	:

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

Provider Enumeration Date	:	05/21/2014
Last Update Date	:	05/21/2014

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Directions to “ YAW OWUSU-POKU PA-C” Practice Location

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