1649413501 NPI number — AFUA MINTAH M.D.

Table of content: AFUA MINTAH M.D. (NPI 1649413501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649413501 NPI number — AFUA MINTAH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MINTAH
Provider First Name:
AFUA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1649413501
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 UNIVERSITY DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
NEWTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18940-1873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-322-5042
Provider Business Mailing Address Fax Number:
215-322-5043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
178 W STREET RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FEASTERVILLE TREVOSE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19053-7817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-322-5042
Provider Business Practice Location Address Fax Number:
215-322-5043
Provider Enumeration Date:
04/08/2009

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: 207V00000X , with the licence number:  271088 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: MD456511 , 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)

  • Identifier: 6759978 . This is a "CIGNA PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30245975 . This is a "KEYSTONE FIRST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3345622 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P01618701 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3941088000 . This is a "KEYSTONE IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 9983609 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 103086160001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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