Provider Demographics
NPI:1992423313
Name:BENJAMIN YEBOAH MD, LLC
Entity type:Organization
Organization Name:BENJAMIN YEBOAH MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR/ONWER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YEBOAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-812-9706
Mailing Address - Street 1:47 WATERBURY RD STE 155
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-1256
Mailing Address - Country:US
Mailing Address - Phone:203-813-9706
Mailing Address - Fax:
Practice Address - Street 1:33 CONE AVE
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-4822
Practice Address - Country:US
Practice Address - Phone:203-238-1606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty