Provider Demographics
NPI:1720465495
Name:OMESIETE, NKECHINYE PAMELA (MD)
Entity Type:Individual
Prefix:
First Name:NKECHINYE
Middle Name:PAMELA
Last Name:OMESIETE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NKECHINYE
Other - Middle Name:PAMELA
Other - Last Name:OMESIETE ADEJARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8921 MAXWELL PL
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-1517
Mailing Address - Country:US
Mailing Address - Phone:267-439-6733
Mailing Address - Fax:
Practice Address - Street 1:1 ATWELL RD
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-1301
Practice Address - Country:US
Practice Address - Phone:607-547-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-01
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME158441208600000X
FLME155441208C00000X
390200000X
NY326289208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program