Basic Information
| Provider Information | |||||||||
| NPI: | 1427298215 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SARPONG | ||||||||
| FirstName: | AYESHA | ||||||||
| MiddleName: | ADJEI | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 65 OAKLAWN AVE | ||||||||
| Address2: | APT 103 | ||||||||
| City: | CRANSTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029209386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239261171 | ||||||||
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| Practice Location | |||||||||
| Address1: | 65 OAKLAWN AVE | ||||||||
| Address2: | APT 103 | ||||||||
| City: | CRANSTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029209386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198243991 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2009 | ||||||||
| LastUpdateDate: | 06/03/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | D0075646 | MD | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.