Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | D0085085 | MD |
Y | 207K00000X | Allergist & Immunologist | TMD004640 | PA |
NPI | 1205198512 |
---|---|
Provider Name | Dr. Ogechukwu Ndum |
First Address | Danville, PA 17822-4903 |
Second Address | Dunmore, PA 18512-3195 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2012 |
Last Update Date | 19/10/2020 |