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:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 E BRAMBLETON AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2905
Mailing Address - Country:US
Mailing Address - Phone:757-393-1136
Mailing Address - Fax:757-533-9441
Practice Address - Street 1:549 E BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2905
Practice Address - Country:US
Practice Address - Phone:757-393-1136
Practice Address - Fax:757-533-9441
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2025-05-23
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