Provider Demographics
NPI:1578717815
Name:KENTA-BIBI, EUCHARIA MAMBO (MD)
Entity Type:Individual
Prefix:
First Name:EUCHARIA
Middle Name:MAMBO
Last Name:KENTA-BIBI
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 1:1000 SILVER STREET
Mailing Address - Street 2:CONNECTICUT VALLEY HOSPITAL
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-7023
Mailing Address - Country:US
Mailing Address - Phone:860-262-5154
Mailing Address - Fax:860-262-5122
Practice Address - Street 1:1000 SILVER STREET
Practice Address - Street 2:CONNECTICUT VALLEY HOSPITAL
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-7023
Practice Address - Country:US
Practice Address - Phone:860-262-5154
Practice Address - Fax:860-262-5122
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT051460207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine