Provider Demographics
NPI:1023103587
Name:ASAMOAH-MENSAH, NANA YAW (MD)
Entity type:Individual
Prefix:
First Name:NANA
Middle Name:YAW
Last Name:ASAMOAH-MENSAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12601 BRIDOON LANE
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-5828
Mailing Address - Country:US
Mailing Address - Phone:703-587-5048
Mailing Address - Fax:
Practice Address - Street 1:1140 VARNUM ST NE
Practice Address - Street 2:SUITE 205
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2153
Practice Address - Country:US
Practice Address - Phone:202-269-0499
Practice Address - Fax:202-269-0855
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0352242084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC036318200Medicaid
DCG01920Medicare PIN
DC036318200Medicaid
DC190485YCD7Medicare PIN