MEDICARE: KWASI A DEBRA 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	207VG0400X	Gynecology Physician	D0040683	MD
2	207V00000X	Obstetrics & Gynecology Physician	MD20163	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1026004806	OTHER	MD	CIGNA
2	925694	OTHER	MD	MAMSI
3	H9050001	OTHER	MD	BLUECROSS BLUESHIELD
4	52507102	OTHER	MD	CAREFIRST BC BS OF MD
5	4561470	OTHER	MD	AETNA
6	703633	OTHER	MD	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1972512408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KWASI A DEBRA MD

Provider Business Mailing Address
First Line	:	12200 ANNAPOLIS RD
Second Line	:	STE 123
City	:	GLENN DALE
State	:	MD
Zip	:	20769-9182
Country	:	US
Telephone Number	:	301-552-9495
Fax Number	:	301-552-9743

Provider Business Practice Location Address
First Line	:	12200 ANNAPOLIS RD
Second Line	:	STE 123
City	:	GLENN DALE
State	:	MD
Zip	:	20769-9182
Country	:	US
Telephone Number	:	301-552-9495
Fax Number	:	301-552-9743

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	04/04/2017

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Directions to “ KWASI A DEBRA MD” Practice Location

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