Provider Demographics
NPI:1871908566
Name:OWUSU-AGYEI, JUSTICE (MD)
Entity type:Individual
Prefix:
First Name:JUSTICE
Middle Name:
Last Name:OWUSU-AGYEI
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 1:801 OSTRUM ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1000
Mailing Address - Country:US
Mailing Address - Phone:845-266-0484
Mailing Address - Fax:
Practice Address - Street 1:701 OSTRUM ST STE 602
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1184
Practice Address - Country:US
Practice Address - Phone:484-526-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-22
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD473081207T00000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery