Provider Demographics
NPI:1134611189
Name:AMEWUAME EPSE KPEHOR, ATSOUFUI NYUIEGOME ELOM (MD)
Entity type:Individual
Prefix:
First Name:ATSOUFUI
Middle Name:NYUIEGOME ELOM
Last Name:AMEWUAME EPSE KPEHOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DANIELA
Other - Middle Name:
Other - Last Name:KPEHOR-AMEWUAME
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1200 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3720
Practice Address - Country:US
Practice Address - Phone:215-481-2606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT217136207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program