Basic Information
| Provider Information | |||||||||
| NPI: | 1881668937 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OTCHERE-BOATENG | ||||||||
| FirstName: | YAW | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| OtherLastName: | OTCHERE-BOATENG | ||||||||
| OtherFirstName: | YAW | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1005 CARRINGTON CT | ||||||||
| Address2: | |||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376605694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2367770404 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1627 QUARRIER ST | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253112124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575362246 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 02/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 207P00000X | 40708 | TN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | 0101242839 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 40708 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RA0401X | FO3926663 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine | 208M00000X | 40708 | TN | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 43217 | KY | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 29872 | WV | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.