Provider Demographics
NPI:1881713337
Name:ASHANTI MEDICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:ASHANTI MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KOFI
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTA-MENSAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-714-2992
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT26698207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010026698CT04OtherBCBS
CTDN7801OtherRAILROAD MEDICARE PART B
CT2V9515OtherHEALTHNET
CT026698OtherCONNECTICARE
CT100002036OtherRAILROAD MEDICARE
CT566029OtherAETNA
CT001266980Medicaid
CT0577990OtherCIGNA HEALTHCARE
CT298481OtherWELLCARE SPECIALTY
CT311575OtherWELLCARE
CT29-00882OtherEVERCARE
CTHAP358OtherOXFORD HEALTHCARE
CT001266980Medicaid
CTDN7801OtherRAILROAD MEDICARE PART B