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NPI Code Detail

MEDICARE: MARY IGBOELI MD

MEDICARE: MARY IGBOELI MD
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
1390200000XStudent in an Organized Health Care Education/Training Program
22084P0800XPsychiatry Physician25MA12236900NJ
32084P0800XPsychiatry PhysicianMD494178PA

General Provider Information

NPI Number : 1639798606
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY IGBOELI MD
Provider Business Mailing Address
First Line : 2100 MACK BLVD FL 4
Second Line :
City : ALLENTOWN
State : PA
Zip : 18103-5622
Country : US
Telephone Number : 484-884-4500
Fax Number :
Provider Business Practice Location Address
First Line : 2545 SCHOENERSVILLE RD FL 5
Second Line :
City : BETHLEHEM
State : PA
Zip : 18017-7300
Country : US
Telephone Number : 484-884-6503
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2020
Last Update Date : 04/06/2026

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Directions to “ MARY IGBOELI MD” Practice Location

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