1053841601 NPI number — DR. YOHANCE MANDELA ALLETTE MD, PHD

Table of content: DR. YOHANCE MANDELA ALLETTE MD, PHD (NPI 1053841601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053841601 NPI number — DR. YOHANCE MANDELA ALLETTE MD, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLETTE
Provider First Name:
YOHANCE
Provider Middle Name:
MANDELA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053841601
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 HOPE DRIVE
Provider Second Line Business Mailing Address:
MAIL CODE EC037, SUITE 1300
Provider Business Mailing Address City Name:
HERSHEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-531-3828
Provider Business Mailing Address Fax Number:
717-531-4694

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 HOPE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERSHEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17033-2036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-531-3828
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , with the licence number:  11019519A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: MD482394 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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