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1720465495 NPI number — NKECHINYE PAMELA OMESIETE MD

NPI Number: 1720465495
Health Care Provider/Practitioner: NKECHINYE PAMELA OMESIETE MD

Information about “1720465495” NPI (NKECHINYE PAMELA OMESIETE MD) exists in 1720465495 in HTML format HTML  |  1720465495 in plain Text format TXT  |  1720465495 in PDF (Portable Document Format) PDF  |  1720465495 in an XML format XML  formats.

NPI Number : 1720465495 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720465495",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "OMESIETE",
    "FirstName": "NKECHINYE",
    "MiddleName": "PAMELA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "OMESIETE ADEJARE",
    "OtherFirstName": "NKECHINYE",
    "OtherMiddleName": "PAMELA",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "8921 MAXWELL PL",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PHILADELPHIA",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "19152-1517",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "267-439-6733",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1 ATWELL RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COOPERSTOWN",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "13326-1301",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "607-547-6300",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/01/2015",
    "LastUpdateDate": "01/02/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "208600000X",
          "TaxonomyName": "Surgery Physician",
          "LicenseNumber": "ME158441",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "208C00000X",
          "TaxonomyName": "Colon & Rectal Surgery Physician",
          "LicenseNumber": "ME155441",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "208600000X",
          "TaxonomyName": "Surgery Physician",
          "LicenseNumber": "326289",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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