Individual
DR. EGEDE J AITSEBAOMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 887-2289
(570) 887-2290
Mailing address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
285781
NY
207RC0000X
Cardiovascular Disease Physician
Primary
MD459847
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8913023
—
NC
Enumeration date
11/01/2006
Last updated
03/14/2021
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