Healthcare Provider Details

I. General information

NPI: 1649537788
Provider Name (Legal Business Name): GANIYU T. AMUSA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W LANCASTER AVE
PAOLI PA
19301-1763
US

IV. Provider business mailing address

610 W GERMANTOWN PIKE STE 150
PLYMOUTH MEETING PA
19462-1062
US

V. Phone/Fax

Practice location:
  • Phone: 484-565-1000
  • Fax:
Mailing address:
  • Phone: 610-525-4966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA10047300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD475604
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: