Basic Information
| Provider Information | |||||||||
| NPI: | 1710253141 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AMOAKO | ||||||||
| FirstName: | ADAE | ||||||||
| MiddleName: | OPOKU | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1221 MERCANTILE LN | ||||||||
| Address2: | |||||||||
| City: | UPPER MARLBORO | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207745374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016185500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1221 MERCANTILE LN | ||||||||
| Address2: | |||||||||
| City: | UPPER MARLBORO | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207745374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016185500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2012 | ||||||||
| LastUpdateDate: | 06/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD044533 | DC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 0101261068 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | D0082083 | MD | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QS0010X | 0101261068 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207QS0010X | MD044533 | DC | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207QS0010X | D0082083 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
No ID Information.