Basic Information
| Provider Information | |||||||||
| NPI: | 1205320934 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BOAH & BOAH M.D P.C | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | WILLIAM O BOAH MD LLP | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 145 E 18TH ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112264362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182829690 | ||||||||
| FaxNumber: | 7182875915 | ||||||||
| Practice Location | |||||||||
| Address1: | 145 E 18TH ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112264362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182829690 | ||||||||
| FaxNumber: | 7182875915 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2018 | ||||||||
| LastUpdateDate: | 06/16/2018 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BOAH | ||||||||
| AuthorizedOfficialFirstName: | AKUA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MD/ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7182829690 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 000368447 | 05 | NY | MEDICAID |