Provider Demographics
NPI:1982667069
Name:NNEBE, NKIRUKA SANDRA (MD)
Entity Type:Individual
Prefix:
First Name:NKIRUKA
Middle Name:SANDRA
Last Name:NNEBE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:NNEBE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2500 MARYLAND RD STE 504
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1226
Mailing Address - Country:US
Mailing Address - Phone:215-481-6836
Mailing Address - Fax:215-481-5788
Practice Address - Street 1:10800 KNIGHTS RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-4200
Practice Address - Country:US
Practice Address - Phone:215-612-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426961207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA95398OtherGEISINGER HEALTH PLAN
PANN1757955OtherHIGHMARK BLUE SHIELD
PA1014682300001Medicaid
PA50054406OtherCAPITAL BLUE CROSS
PAP00268548OtherRAILROAD MEDICARE
PA094374KNCMedicare ID - Type UnspecifiedHGSA
PA1014682300001Medicaid