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NPI Code Detail

MEDICARE: FIDELIS O EJIANREH D.O.

MEDICARE: FIDELIS O EJIANREH D.O.
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
1207Q00000XFamily Medicine PhysicianBE8240652PA

General Provider Information

NPI Number : 1699746990
Entity Type Code : Individual
Provider Name (Legal Business Name) : FIDELIS O EJIANREH D.O.
Provider Business Mailing Address
First Line : 811 CRICKLEWOOD DR
Second Line :
City : STATE COLLEGE
State : PA
Zip : 16803-1899
Country : US
Telephone Number : 814-234-2226
Fax Number : 814-234-2258
Provider Business Practice Location Address
First Line : 2032 E PLEASANT VALLEY BLVD
Second Line :
City : ALTOONA
State : PA
Zip : 16602
Country : US
Telephone Number : 814-684-3101
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2006
Last Update Date : 03/11/2019

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