Provider Demographics
NPI:1316467251
Name:KWARTENG, ODURO
Entity type:Individual
Prefix:
First Name:ODURO
Middle Name:
Last Name:KWARTENG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CRYSTAL SPRING DR
Mailing Address - Street 2:
Mailing Address - City:ASHTON
Mailing Address - State:MD
Mailing Address - Zip Code:20861-3601
Mailing Address - Country:US
Mailing Address - Phone:240-722-6480
Mailing Address - Fax:
Practice Address - Street 1:101 CRYSTAL SPRING DR
Practice Address - Street 2:
Practice Address - City:ASHTON
Practice Address - State:MD
Practice Address - Zip Code:20861-3601
Practice Address - Country:US
Practice Address - Phone:240-722-6480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2471N0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine Technology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK-635-652-021-344Medicaid