Healthcare Provider Details

I. General information

NPI: 1699262154
Provider Name (Legal Business Name): IBORO CHARLES UMANA PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 MANNING ST
PHILADELPHIA PA
19106
US

IV. Provider business mailing address

719 MANNING ST BLDG 4TH
PHILADELPHIA PA
19106
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-3561
  • Fax:
Mailing address:
  • Phone: 215-829-3561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number103889
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: