Basic Information
| Provider Information | |||||||||
| NPI: | 1891014684 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AMEYAW | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | AMEYAW | ||||||||
| OtherFirstName: | SAMUEL | ||||||||
| OtherMiddleName: | K | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD CWSP PNS CSA OPA | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 327 SAINT MARYS AVE APT G | ||||||||
| Address2: | |||||||||
| City: | LA PLATA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206465950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013923887 | ||||||||
| FaxNumber: | 3013923887 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 GARRETT AVE | ||||||||
| Address2: | |||||||||
| City: | LA PLATA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206465960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016094000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2010 | ||||||||
| LastUpdateDate: | 09/28/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZC0007X | 238.000191 | IL | N | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Certified First Assistant | 246ZC0007X | 3020 | MD | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Certified First Assistant | 246ZS0410X | 651855 | MD | N | 133N00000X | N | Dietary & Nutritional Service Providers | Nutritionist | 133NN1002X | N | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education | 174H00000X | N | Other Service Providers | Health Educator | 246ZX2200X | 1180 | MD | N |
No ID Information.