Healthcare Provider Details

I. General information

NPI: 1730810094
Provider Name (Legal Business Name): MIREILLE BESSEM NKONGHO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2022
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 S COLDBROOK AVE
CHAMBERSBURG PA
17201-2712
US

IV. Provider business mailing address

112 N 7TH ST
CHAMBERSBURG PA
17201-1720
US

V. Phone/Fax

Practice location:
  • Phone: 717-267-7480
  • Fax: 717-775-5015
Mailing address:
  • Phone: 717-267-7480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD015956
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD494646
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: