Healthcare Provider Details

I. General information

NPI: 1639224371
Provider Name (Legal Business Name): NOAH SSEMAKULA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 04/28/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CONEMAUGH NASON MEDICAL CENTER 105 NASON DR
ROARING SPRING PA
16673
US

IV. Provider business mailing address

CONEMAUGH NASON MEDICAL CENTER 105 NASON DR
ROARING SPRING PA
16673
US

V. Phone/Fax

Practice location:
  • Phone: 814-224-2555
  • Fax:
Mailing address:
  • Phone: 814-224-2555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-061012-L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number44897
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number01044552A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: