1982667069 NPI number — NKIRUKA SANDRA NNEBE M.D.

Table of content: NKIRUKA SANDRA NNEBE M.D. (NPI 1982667069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982667069 NPI number — NKIRUKA SANDRA NNEBE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NNEBE
Provider First Name:
NKIRUKA
Provider Middle Name:
SANDRA
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:
NNEBE
Provider Other First Name:
SANDRA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1982667069
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 MARYLAND RD STE 504
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLOW GROVE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19090-1226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-481-6836
Provider Business Mailing Address Fax Number:
215-481-5788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10800 KNIGHTS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19114-4200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-612-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2006

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:  MD426961 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: MD426961 , 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: 95398 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: NN1757955 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1014682300001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50054406 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00268548 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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