Healthcare Provider Details

I. General information

NPI: 1477112191
Provider Name (Legal Business Name): PETER FATHY TEMSAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST
LEXINGTON KY
40536-2501
US

IV. Provider business mailing address

6610 GRAND AVE APT 2A
MASPETH NY
11378-2501
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-2222
  • Fax: 859-323-5090
Mailing address:
  • Phone: 201-471-8112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberNA
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number60179
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: