Provider Demographics
NPI:1649818907
Name:BOADU, AUGUSTINA O
Entity type:Individual
Prefix:
First Name:AUGUSTINA
Middle Name:O
Last Name:BOADU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AUGUSTINA
Other - Middle Name:O
Other - Last Name:BOADU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:32 FAIRHILL LN
Mailing Address - Street 2:
Mailing Address - City:INDIAN HEAD
Mailing Address - State:MD
Mailing Address - Zip Code:20640-1577
Mailing Address - Country:US
Mailing Address - Phone:303-684-2767
Mailing Address - Fax:
Practice Address - Street 1:32 FAIRHILL LN
Practice Address - Street 2:
Practice Address - City:INDIAN HEAD
Practice Address - State:MD
Practice Address - Zip Code:20640-1577
Practice Address - Country:US
Practice Address - Phone:303-684-2767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDB300074667863343900000X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)