Provider Demographics
NPI:1639224371
Name:SSEMAKULA, NOAH (MD)
Entity Type:Individual
Prefix:DR
First Name:NOAH
Middle Name:
Last Name:SSEMAKULA
Suffix:
Gender:M
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:CONEMAUGH NASON MEDICAL CENTER
Mailing Address - Street 2:105 NASON DR
Mailing Address - City:ROARING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:16673
Mailing Address - Country:US
Mailing Address - Phone:814-224-2555
Mailing Address - Fax:
Practice Address - Street 1:CONEMAUGH NASON MEDICAL CENTER
Practice Address - Street 2:105 NASON DR
Practice Address - City:ROARING SPRING
Practice Address - State:PA
Practice Address - Zip Code:16673
Practice Address - Country:US
Practice Address - Phone:814-224-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO448972080N0001X
IN01044552A2080N0001X
PAMD-061012-L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000647540OtherANTHEM
IN000000741712OtherANTHEM PROVIDER NUMBER FOR TIN 35-2030653
IN200849110Medicaid
IN000000647540OtherANTHEM