Provider Demographics
NPI:1659984243
Name:MESUMBE, DENNIS MEKOLLE (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:MEKOLLE
Last Name:MESUMBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EBAKO
Other - Middle Name:HENRY
Other - Last Name:MESUMBE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:60 OAK ST
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-2745
Mailing Address - Country:US
Mailing Address - Phone:617-216-7555
Mailing Address - Fax:
Practice Address - Street 1:60 OAK ST
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-2745
Practice Address - Country:US
Practice Address - Phone:617-216-7555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty