Healthcare Provider Details

I. General information

NPI: 1598009284
Provider Name (Legal Business Name): AMEGBO C TOFFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD
NEWARK DE
19718-2200
US

IV. Provider business mailing address

1010 CONCORD AVENUE STE 101
WILMINGTON DE
19802-3366
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-0188
  • Fax:
Mailing address:
  • Phone: 302-777-5551
  • Fax: 302-777-5567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0001217
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA062720
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: