Provider Demographics
NPI:1386141364
Name:AKUAMOAH BOATENG, GLORIA (MD)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:
Last Name:AKUAMOAH BOATENG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GLORIA
Other - Middle Name:
Other - Last Name:AKUAMOAH-BOATENG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:801 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2733
Mailing Address - Country:US
Mailing Address - Phone:855-687-6428
Mailing Address - Fax:
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:855-687-6428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN66451208000000X
TXU86732080N0001X
MN29271208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics