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General NPI Number Information
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NPI Number | 1720465495
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Entity Type | Individual
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Provider Name | NKECHINYE PAMELA OMESIETE MD
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Gender | Female
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Dates
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Enumeration Date | 05/01/2015
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Last Update Date | 01/02/2024
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Provider Practice Location Address
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Address Line | 1 ATWELL RD
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City | COOPERSTOWN
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State | NY
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Zip | 13326-1301
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Country | US
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Telephone | 607-547-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 8921 MAXWELL PL
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City | PHILADELPHIA
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State | PA
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Zip | 19152-1517
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Country | US
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Telephone | 267-439-6733
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME158441
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | ME155441
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 326289
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License Number State | NY
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