MEDICARE: DR. KWAMI DELALI AGBODZA 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	207P00000X	Emergency Medicine Physician	9500799	NC
2	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	20436001	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	:	1831190172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KWAMI DELALI AGBODZA MD

Provider Business Mailing Address
First Line	:	15 WESTLAKE CT
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-5160
Country	:	US
Telephone Number	:	732-961-6453
Fax Number	:	732-961-6453

Provider Business Practice Location Address
First Line	:	15 WESTLAKE CT
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-5160
Country	:	US
Telephone Number	:	732-961-6453
Fax Number	:	732-961-6453

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2025

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