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Individual
MBEMBO BONGUTU
Active
Individual
MBEMBO BONGUTU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD062832L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00026887601
UNIVERA
NY
05
—
0016842690006
—
PA
01
—
01983279
NY MEDICAL ASSISTANCE
NY
01
—
080163990
RR MEDICARE
PA
01
—
1645032
BLUE SHIELD
PA
01
—
2228324
OHIO MEDICAL ASSISTANCE
OH
01
—
323780
UPMC
PA
01
—
7441061
AETNA
PA
01
—
75913
UNISON
PA
01
—
P001411
GATEWAY
PA
Enumeration date
08/15/2005
Last updated
04/26/2013
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