1376505040 NPI number — CLAUDETTE NNEMDI GBEMUDU-JATTO MD

Table of content: CLAUDETTE NNEMDI GBEMUDU-JATTO MD (NPI 1376505040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376505040 NPI number — CLAUDETTE NNEMDI GBEMUDU-JATTO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GBEMUDU-JATTO
Provider First Name:
CLAUDETTE
Provider Middle Name:
NNEMDI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JATTO
Provider Other First Name:
CLAUDETTE
Provider Other Middle Name:
GBEMUDU
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1376505040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2205 FOREST HILLS DR
Provider Second Line Business Mailing Address:
SUITE 12
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17112-1001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-327-4448
Provider Business Mailing Address Fax Number:
717-327-4449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2205 FOREST HILLS DR
Provider Second Line Business Practice Location Address:
SUITE 12
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17112-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-327-4448
Provider Business Practice Location Address Fax Number:
717-327-4449
Provider Enumeration Date:
04/06/2006

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: 207R00000X , with the licence number:  MD071505L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208M00000X , with the licence number: MD071505L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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