Provider Demographics
NPI:1194992172
Name:ABOAGYE, EVELYN ABENA OPPONGWAA (MD)
Entity type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:ABENA OPPONGWAA
Last Name:ABOAGYE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:375 FOUR LEAF LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-6905
Practice Address - Country:US
Practice Address - Phone:434-243-0700
Practice Address - Fax:434-243-0680
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010028332208000000X
OH57013380208000000X
VA0101275037208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00859512OtherRAILROAD MEDICARE
431560263OtherTRICARE WEST
431560263OtherTRICARE WEST