Provider Demographics
NPI:1316706427
Name:KUSI BOATENG, VICTORIA M
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:M
Last Name:KUSI BOATENG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11121 BROOKES RESERVE RD
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-6654
Mailing Address - Country:US
Mailing Address - Phone:240-640-0687
Mailing Address - Fax:
Practice Address - Street 1:1401 MERCANTILE LN STE 200R
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-4312
Practice Address - Country:US
Practice Address - Phone:307-201-3252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies