Provider Demographics
NPI:1508645904
Name:ASAMOAH, SAMUEL (PA)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:ASAMOAH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02880-0229
Mailing Address - Country:US
Mailing Address - Phone:401-788-8757
Mailing Address - Fax:
Practice Address - Street 1:14 WOODRUFF AVE STE 1
Practice Address - Street 2:
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882-3467
Practice Address - Country:US
Practice Address - Phone:401-789-8543
Practice Address - Fax:401-782-8766
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA01820363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant