Basic Information
| Provider Information | |||||||||
| NPI: | 1225326994 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EZEIFE | ||||||||
| FirstName: | NKEMDILIM | ||||||||
| MiddleName: | OBIORAH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 MEDICAL CENTER BLVD | ||||||||
| Address2: | SUITE 404 | ||||||||
| City: | UPLAND | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190133955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106198590 | ||||||||
| FaxNumber: | 6106198591 | ||||||||
| Practice Location | |||||||||
| Address1: | 175 E CHESTER PIKE | ||||||||
| Address2: | |||||||||
| City: | RIDLEY PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190782212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105956000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2011 | ||||||||
| LastUpdateDate: | 11/13/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | MD450603 | PA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | MD450603 | 01 | PA | PA MEDICAL LICENSE | OTHER |