Provider Demographics
NPI:1437194073
Name:GOMBEH-ALIE, SITTA BABY (MD)
Entity Type:Individual
Prefix:
First Name:SITTA
Middle Name:BABY
Last Name:GOMBEH-ALIE
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 1:802 RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-6845
Mailing Address - Country:US
Mailing Address - Phone:302-378-9629
Mailing Address - Fax:
Practice Address - Street 1:640 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3565
Practice Address - Country:US
Practice Address - Phone:302-734-1759
Practice Address - Fax:302-734-4401
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0006901207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000038884Medicaid