Healthcare Provider Details

I. General information

NPI: 1225326994
Provider Name (Legal Business Name): NKEMDILIM OBIORAH EZEIFE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 E CHESTER PIKE
RIDLEY PARK PA
19078-2212
US

IV. Provider business mailing address

30 MEDICAL CENTER BLVD SUITE 404
UPLAND PA
19013-3955
US

V. Phone/Fax

Practice location:
  • Phone: 610-595-6000
  • Fax:
Mailing address:
  • Phone: 610-619-8590
  • Fax: 610-619-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD450603
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: