Healthcare Provider Details

I. General information

NPI: 1578925962
Provider Name (Legal Business Name): YVONNE MBACHU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COOPER PLAZA, KELEMAN 152
CAMDEN NJ
08103-1461
US

IV. Provider business mailing address

1 CAPITAL WAY EMERGENCY DEPARTMENT
HOPEWELL PA
08534
US

V. Phone/Fax

Practice location:
  • Phone: 856-342-2627
  • Fax:
Mailing address:
  • Phone: 609-303-4010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA10395900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: