Provider Demographics
NPI:1376505040
Name:GBEMUDU-JATTO, CLAUDETTE NNEMDI (MD)
Entity Type:Individual
Prefix:
First Name:CLAUDETTE
Middle Name:NNEMDI
Last Name:GBEMUDU-JATTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CLAUDETTE
Other - Middle Name:GBEMUDU
Other - Last Name:JATTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2205 FOREST HILLS DR
Mailing Address - Street 2:SUITE 12
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-1001
Mailing Address - Country:US
Mailing Address - Phone:717-327-4448
Mailing Address - Fax:717-327-4449
Practice Address - Street 1:2205 FOREST HILLS DR
Practice Address - Street 2:SUITE 12
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-1001
Practice Address - Country:US
Practice Address - Phone:717-327-4448
Practice Address - Fax:717-327-4449
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071505L207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
H22136Medicare UPIN
PA040202Medicare ID - Type Unspecified