MEDICARE: DR. UKPERE DANIEL NIMTOR MD; MSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD475587	PA
2	2084P0800X	Psychiatry Physician	MD17353	RI
3	2084P0800X	Psychiatry Physician	25MA10967600	NJ
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ00975600	NJ

General Provider Information

NPI Number	:	1336626498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. UKPERE DANIEL NIMTOR MD; MSN

Provider Business Mailing Address
First Line	:	140 NUTT RD
Second Line	:
City	:	PHOENIXVILLE
State	:	PA
Zip	:	19460-3906
Country	:	US
Telephone Number	:	610-983-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 SECOND AVE
Second Line	:
City	:	COLLEGEVILLE
State	:	PA
Zip	:	19426-2658
Country	:	US
Telephone Number	:	485-902-8130
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2018
Last Update Date	:	08/08/2024

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