Healthcare Provider Details

I. General information

NPI: 1851320493
Provider Name (Legal Business Name): EBONDO MPINGA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PINE GROVE CMNS
YORK PA
17403-5176
US

IV. Provider business mailing address

1803 MOUNT ROSE AVE SUITE B3
YORK PA
17403-3026
US

V. Phone/Fax

Practice location:
  • Phone: 717-851-6110
  • Fax: 717-741-1076
Mailing address:
  • Phone: 717-851-1405
  • Fax: 717-851-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD423172
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD423172
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: