Provider Demographics
NPI:1215091376
Name:OWUSU-DAPAAH, KWABENA BARIMAH (MD)
Entity type:Individual
Prefix:DR
First Name:KWABENA
Middle Name:BARIMAH
Last Name:OWUSU-DAPAAH
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 1:710 EASTON AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1855
Mailing Address - Country:US
Mailing Address - Phone:732-246-1960
Mailing Address - Fax:732-246-3141
Practice Address - Street 1:710 EASTON AVE STE 1A
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1855
Practice Address - Country:US
Practice Address - Phone:732-246-1960
Practice Address - Fax:732-246-3141
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA60340174400000X
NJ25MA06034000207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6402909Medicaid
NJ052136QJ2Medicare PIN
G30432Medicare UPIN
930118060Medicare PIN