Provider Demographics
NPI:1487769915
Name:LORRAINE OFORI-AWUAH MD PA
Entity type:Organization
Organization Name:LORRAINE OFORI-AWUAH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:BEATRICE
Authorized Official - Last Name:OFORI-AWUAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-960-8164
Mailing Address - Street 1:9305 GLEN VISTA RD
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128
Mailing Address - Country:US
Mailing Address - Phone:410-933-4970
Mailing Address - Fax:410-933-4971
Practice Address - Street 1:5430 CAMPBELL BLVD
Practice Address - Street 2:STE 214
Practice Address - City:WHITE MARSH
Practice Address - State:MD
Practice Address - Zip Code:21162
Practice Address - Country:US
Practice Address - Phone:410-933-4970
Practice Address - Fax:410-933-4971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDOO61789261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405496200Medicaid
MDI09831Medicare UPIN
MD401PMedicare PIN