Individual
COLLINS KWABENA BOATENG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2070 OLD BRIDGE RD STE 103, LAKERIDGE, VA 22192-2945
(703) 499-8787
(703) 499-8222
Mailing address
2070 OLD BRIDGE RD STE 103, LAKERIDGE, VA 22192-2945
(703) 499-8787
(703) 499-8222
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110005729
VA
363AM0700X
Medical Physician Assistant
0110005729
VA
Other
Enumeration date
04/20/2017
Last updated
05/13/2019
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