Provider Demographics
NPI:1871519264
Name:ATTA-MENSAH, KOFI (MD)
Entity type:Individual
Prefix:
First Name:KOFI
Middle Name:
Last Name:ATTA-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 1:675 TOWER AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112-1260
Mailing Address - Country:US
Mailing Address - Phone:860-714-2992
Mailing Address - Fax:860-714-8990
Practice Address - Street 1:675 TOWER AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-1260
Practice Address - Country:US
Practice Address - Phone:860-714-2992
Practice Address - Fax:860-714-8990
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT26698207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT29-00882OtherEVERCARE
CT2V9515OtherHEALTHNET
CTP00638369OtherRAILROAD MEDICARE PART B
CT100002036OtherRAILROAD MEDICARE
CT001266980Medicaid
CT311575OtherWELLCARE - PCP
CT010026698CT04OtherBLUE CROSS/BLUE SHILED
CT0577990OtherCIGNA HEALTHCARE
CT566029OtherAETNA
CTHAP358OtherOXFORD
CT298481OtherWELLCARE SPECIALTY
CT026698OtherCONNECTICARE
CT2V9515OtherHEALTHNET
CT010026698CT04OtherBLUE CROSS/BLUE SHILED
CT29-00882OtherEVERCARE