1972566800 NPI number — UDEME U INYANG M.D.

Table of content: UDEME U INYANG M.D. (NPI 1972566800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972566800 NPI number — UDEME U INYANG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
INYANG
Provider First Name:
UDEME
Provider Middle Name:
U
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:
ESSIEN
Provider Other First Name:
UDEME
Provider Other Middle Name:
U
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972566800
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3421 CONCORD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17402-9001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-851-1405
Provider Business Mailing Address Fax Number:
717-851-6969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 S GEORGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17403-3676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-812-7687
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2006

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: 207L00000X , with the licence number:  MD424245 , 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: 0290068 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50103369 . This is a "CAPITAL BLUECROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 100934664 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00962402 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 12108089 . This is a "CAQH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".