Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mboutidem Etokakpan, MD

Individual provider Surgery Physician · NPI 1467851634

Mboutidem Etokakpan, MD is a General Surgery in Hazle Township, Pennsylvania. Qualified in 2014, 12 years ago. Practices with Lehigh Valley Physician Group, a 2,493-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Ohio and Pennsylvania.

Years since qualifying
12
Licensed in
OH, PA
In the registry since
2014
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

50 Moisey Dr
Hazle Township, PA 18202-9297
Phone: (570) 501-6900
Fax: (570) 501-6945
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgery Physician (primary) Taxonomy 208600000X · Licence MD469829 (PA)
Surgery Physician Taxonomy 208600000X · Licence 35.138339 (OH)

Record details

NPI number1467851634
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedAugust 14, 2014
Last updated in NPPESJuly 26, 2022
Certification dateJuly 26, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyGENERAL SURGERY
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Lehigh Valley Physician Group — 2493 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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