Provider Demographics
NPI:1578069035
Name:OSIFO, EBELECHUKWU KENE (MD)
Entity Type:Individual
Prefix:
First Name:EBELECHUKWU
Middle Name:KENE
Last Name:OSIFO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EBELECHUKWU
Other - Middle Name:KENE
Other - Last Name:OKAFOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-812-5229
Mailing Address - Fax:717-266-7453
Practice Address - Street 1:235 ROSEDALE DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:PA
Practice Address - Zip Code:17345-1022
Practice Address - Country:US
Practice Address - Phone:717-812-5229
Practice Address - Fax:717-266-7453
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD475469207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine