Provider Demographics
NPI:1154408227
Name:AKYEA DJAMSON, AYIM KWASI (MD FACC)
Entity type:Individual
Prefix:
First Name:AYIM
Middle Name:KWASI
Last Name:AKYEA DJAMSON
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1234
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20725
Mailing Address - Country:US
Mailing Address - Phone:301-262-3755
Mailing Address - Fax:301-464-9465
Practice Address - Street 1:10756 RHODE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2513
Practice Address - Country:US
Practice Address - Phone:301-595-0356
Practice Address - Fax:301-595-0359
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050898174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD134402100Medicaid
MDG01328Medicare ID - Type Unspecified
MD134402100Medicaid