Provider Demographics
NPI:1720774664
Name:IBE, FESTUS OKECHUKWU (MD)
Entity type:Individual
Prefix:
First Name:FESTUS
Middle Name:OKECHUKWU
Last Name:IBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ALBERT EINSTEIN MEDICAL CENTER
Mailing Address - Street 2:5501 OLD YORK ROAD
Mailing Address - City:PHILADELPHA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3018
Mailing Address - Country:US
Mailing Address - Phone:215-456-8220
Mailing Address - Fax:215-456-5820
Practice Address - Street 1:ALBERT EINSTEIN MEDICAL CENTER
Practice Address - Street 2:5501 OLD YORK ROAD
Practice Address - City:PHILADELPHA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-456-8220
Practice Address - Fax:215-456-5820
Is Sole Proprietor?:No
Enumeration Date:2023-04-13
Last Update Date:2024-11-15
Deactivation Date:2023-11-17
Deactivation Code:
Reactivation Date:2024-11-15
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMT228572207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program