Provider Demographics
NPI:1114650983
Name:KEVU, ESEOGHENE PRISCILLA (ND)
Entity Type:Individual
Prefix:
First Name:ESEOGHENE
Middle Name:PRISCILLA
Last Name:KEVU
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LANCASTER AVENUE
Mailing Address - Street 2:ANNENBERG G-10
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096
Mailing Address - Country:US
Mailing Address - Phone:445-444-5126
Mailing Address - Fax:
Practice Address - Street 1:100 E LANCASTER AVENUE
Practice Address - Street 2:ANNENBERG G-10
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096
Practice Address - Country:US
Practice Address - Phone:484-476-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT226384207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine