Provider Demographics
NPI:1801097084
Name:OWUSU-ANTWI, KOFI (MD)
Entity type:Individual
Prefix:DR
First Name:KOFI
Middle Name:
Last Name:OWUSU-ANTWI
Suffix:
Gender:M
Credentials:MD
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 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-225-8000
Mailing Address - Fax:
Practice Address - Street 1:827 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4606
Practice Address - Country:US
Practice Address - Phone:410-225-8790
Practice Address - Fax:410-225-8910
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0066568207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD413931300Medicaid
MDS062-0506OtherCAREFIRST
MD413931300Medicaid
MDP01373571Medicare PIN