Provider Demographics
NPI:1487984753
Name:MBIH, IRENE MBUNUE MINANG (MD)
Entity type:Individual
Prefix:MS
First Name:IRENE
Middle Name:MBUNUE MINANG
Last Name:MBIH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MBUNUE
Other - Middle Name:IRENE
Other - Last Name:MINANG
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-1951
Practice Address - Country:US
Practice Address - Phone:570-214-9585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN54964207R00000X
OH390200000X
PAMD459574208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program