Basic Information
| Provider Information | |||||||||
| NPI: | 1609034628 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KODUAH | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | YAW | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18300 THUNDERCLOUD RD | ||||||||
| Address2: | |||||||||
| City: | BOYDS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208414380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013796158 | ||||||||
| FaxNumber: | 3015405073 | ||||||||
| Practice Location | |||||||||
| Address1: | 3001 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | CHEVERLY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207851189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016183772 | ||||||||
| FaxNumber: | 3016182986 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2008 | ||||||||
| LastUpdateDate: | 06/17/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D0069606 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.