Provider Demographics
NPI:1588794192
Name:BOSAH, AUGUSTINE O (MD)
Entity type:Individual
Prefix:DR
First Name:AUGUSTINE
Middle Name:O
Last Name:BOSAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1501 SENTINEL DR STE 407
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4471
Mailing Address - Country:US
Mailing Address - Phone:757-276-7585
Mailing Address - Fax:877-485-8290
Practice Address - Street 1:1501 SENTINEL DR STE 407
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4471
Practice Address - Country:US
Practice Address - Phone:757-276-7585
Practice Address - Fax:877-485-8290
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101244465207R00000X
TXP9475207R00000X
NMMD2016-0633207RG0300X
AZ42980207RG0300X
TXR9475207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine