Provider Demographics
NPI:1033553540
Name:EMESUE, EVANGELINE IFEOMA (MD)
Entity Type:Individual
Prefix:
First Name:EVANGELINE
Middle Name:IFEOMA
Last Name:EMESUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MARKET PLAZA WAY
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-5659
Mailing Address - Country:US
Mailing Address - Phone:717-766-0228
Mailing Address - Fax:
Practice Address - Street 1:2401 PARK DR STE 101
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-9303
Practice Address - Country:US
Practice Address - Phone:717-686-9842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-26
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD459402207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine