Individual
ETIENO USEN UMOBONG
Active
Individual
ETIENO USEN UMOBONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD471227
PA
207RP1001X
Pulmonary Disease Physician
Primary
MD471227
PA
208600000X
Surgery Physician
MT200560
PA
390200000X
Student in an Organized Health Care Education/Training Program
TO BE ISSUED
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103787651
—
PA
Enumeration date
06/26/2011
Last updated
08/27/2021
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