Provider Demographics
NPI:1124289103
Name:AMO-MENSAH, KOFI (MD)
Entity type:Individual
Prefix:DR
First Name:KOFI
Middle Name:
Last Name:AMO-MENSAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:KOFI
Other - Middle Name:
Other - Last Name:AMO-MENSAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5715
Mailing Address - Fax:540-224-5684
Practice Address - Street 1:180 FLOYD AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-1318
Practice Address - Country:US
Practice Address - Phone:540-483-5277
Practice Address - Fax:540-489-6459
Is Sole Proprietor?:No
Enumeration Date:2008-06-22
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC7207R00000X
VA0101250432207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1124289103Medicaid
VAVV3639AMedicare PIN