Provider Demographics
NPI:1619225091
Name:OPOKU-AGYEMAN, JUDE (DO)
Entity type:Individual
Prefix:
First Name:JUDE
Middle Name:
Last Name:OPOKU-AGYEMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2672
Mailing Address - Country:US
Mailing Address - Phone:610-667-1888
Mailing Address - Fax:
Practice Address - Street 1:19 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-2672
Practice Address - Country:US
Practice Address - Phone:610-667-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS019567208200000X
MA252894208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery