Healthcare Provider Details

I. General information

NPI: 1801989777
Provider Name (Legal Business Name): YODIT J. KEFLEMARIAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1648 HUNTINGDON PIKE
MEADOWBROOK PA
19046
US

IV. Provider business mailing address

1648 HUNTINGDON PIKE
MEADOWBROOK PA
19046-8001
US

V. Phone/Fax

Practice location:
  • Phone: 215-938-4602
  • Fax:
Mailing address:
  • Phone: 215-938-4602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD435123
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA08102600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: