Provider Demographics
NPI:1184807877
Name:AMANKONA, RAYMOND KOFI (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:KOFI
Last Name:AMANKONA
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 1:1060 FIRST COLONIAL RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3002
Mailing Address - Country:US
Mailing Address - Phone:757-395-2323
Mailing Address - Fax:757-827-2255
Practice Address - Street 1:1060 FIRST COLONIAL RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3002
Practice Address - Country:US
Practice Address - Phone:757-395-2323
Practice Address - Fax:757-827-2255
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTMEDICAL RESIDENT207R00000X
VA0101249825207R00000X, 208M00000X
CT047768208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1184807877Medicaid
VAVV1819BMedicare PIN
VAVV1819AMedicare PIN
VAP01176851Medicare PIN