Healthcare Provider Details

I. General information

NPI: 1336630375
Provider Name (Legal Business Name): EMMANUEL CHARLES ADOMFEH MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: EMMANUEL NYARKO-ADOMFEH

II. Dates (important events)

Enumeration Date: 05/25/2018
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 OLD YORK RD DEPT OF
PHILADELPHIA PA
19141-3018
US

IV. Provider business mailing address

5501 OLD YORK RD DEPT OF
PHILADELPHIA PA
19141-3018
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-8640
  • Fax:
Mailing address:
  • Phone: 215-456-8640
  • Fax:

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 StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD474339
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: