Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC006121 | PA |
Y | 222Z00000X | Podiatrist | SC006121 | PA |
N | 213EP0504X | Public Medicine | SC006121 | PA |
N | 213EP1101X | Primary Podiatric Medicine | SC006121 | PA |
N | 111NR0200X | Radiology | SC006121 | PA |
N | 213ER0200X | Radiology | SC006121 | PA |
N | 2081S0010X | Sports Medicine | SC006121 | PA |
N | 213ES0000X | Sports Medicine | SC006121 | PA |
N | 213ES0103X | Foot & Ankle Surgery | SC006121 | PA |
N | 213ES0131X | Foot Surgery | SC006121 | PA |
NPI | 1396973152 |
---|---|
Provider Name | Dr. Kwasi Y Kwaadu |
First Address | Philadelphia, PA 19107-2496 |
Second Address | Philadelphia, PA 19107-2496 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2009 |
Last Update Date | 13/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102711775 | (05) | PA |
3884275000 | IBX (01) | PA |
9152882 | AETNA (01) | PA |