Basic Information
| Provider Information | |||||||||
| NPI: | 1194164780 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AMOUSSOU-KPETO | ||||||||
| FirstName: | ELOM | ||||||||
| MiddleName: | DOWUIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2118 SPRING VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176012427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175440150 | ||||||||
| FaxNumber: | 7175440151 | ||||||||
| Practice Location | |||||||||
| Address1: | 2118 SPRING VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176012427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175440150 | ||||||||
| FaxNumber: | 7175440151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2013 | ||||||||
| LastUpdateDate: | 07/18/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MT205019 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.