Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 215259-1 | NY |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | MD049700L | PA |
NPI | 1063489524 |
---|---|
Provider Name | Nche Zama |
First Address | Elmira, NY 14901-3230 |
Second Address | East Stroudsburg, PA 18301-3006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2006 |
Last Update Date | 06/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0014325660004 | (05) | PA |
0014325660008 | (05) | PA |
0014325660009 | (05) | PA |
01948801 | (05) | NY |
0650047000 | KEYSTONE IBC (01) | PA |
3416861 | AETNA (01) | PA |
741362 | HIGHMARK BLUE SHIELD (01) | PA |
F06555 | (02) |