Healthcare Provider Details

I. General information

NPI: 1487984753
Provider Name (Legal Business Name): IRENE MBUNUE MINANG MBIH M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MBUNUE IRENE MINANG I M.D

II. Dates (important events)

Enumeration Date: 01/07/2010
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ACADEMY AVE
DANVILLE PA
17822-1951
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-214-9585
  • Fax:
Mailing address:
  • Phone: 570-271-6144
  • Fax: 570-271-6578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number54964
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD459574
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: