Provider Demographics
NPI:1427282631
Name:OWUSU-BOAHEN, OLIVIA (MD)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:OWUSU-BOAHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:
Other - Last Name:ADJEKUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:34301 GRAHAM CIR
Mailing Address - Street 2:
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-3195
Mailing Address - Country:US
Mailing Address - Phone:201-281-2051
Mailing Address - Fax:
Practice Address - Street 1:100 E CARROLL ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5422
Practice Address - Country:US
Practice Address - Phone:201-281-2051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08613500208000000X, 2080P0204X
DEC1-0027947208000000X
PAMD4533582080P0204X
390200000X
MDD0094133208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102375814Medicaid