MEDICARE: DR. UCHECHI IFEOMA ODDIRI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	288353	NY
2	2080P0203X	Pediatric Critical Care Medicine Physician	288353	NY

General Provider Information

NPI Number	:	1073808614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. UCHECHI IFEOMA ODDIRI M.D.

Provider Business Mailing Address
First Line	:	HSC T11 RM 020
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11794-8111
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	HSC T11 RM 020
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11794-1425
Country	:	US
Telephone Number	:	631-444-2710
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2011
Last Update Date	:	04/28/2022

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