Healthcare Provider Details

I. General information

NPI: 1124515838
Provider Name (Legal Business Name): BASILIO NII AYITEY ADDO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date: 11/28/2018
Reactivation Date: 07/08/2019

III. Provider practice location address

1001 S GEORGE ST
YORK PA
17403-3676
US

IV. Provider business mailing address

1001 S GEORGE ST
YORK PA
17403-3676
US

V. Phone/Fax

Practice location:
  • Phone: 717-741-8003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD488427
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number88806
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD488427
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number88806
License Number StateGA
# 6
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMT235463
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: