Provider Demographics
NPI:1447811872
Name:GAMBRAH, KWASI AMPONSAH (MD)
Entity type:Individual
Prefix:DR
First Name:KWASI
Middle Name:AMPONSAH
Last Name:GAMBRAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:PAUL
Other - Middle Name:AMPONSAH
Other - Last Name:GAMBRAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4605 MACCORKLE AVE SW
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1311
Mailing Address - Country:US
Mailing Address - Phone:304-414-4800
Mailing Address - Fax:
Practice Address - Street 1:1097 FLEDDERJOHN RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25314-4208
Practice Address - Country:US
Practice Address - Phone:304-345-3627
Practice Address - Fax:304-346-4440
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2022-11-21
Deactivation Date:2020-02-10
Deactivation Code:
Reactivation Date:2020-03-02
Provider Licenses
StateLicense IDTaxonomies
WV31544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine