MEDICARE: NKIRUKA UDEKA ARENE 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	207R00000X	Internal Medicine Physician	D63924	MD
2	208100000X	Physical Medicine & Rehabilitation Physician	D63924	MD

General Provider Information

NPI Number	:	1477517332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NKIRUKA UDEKA ARENE M.D.

Provider Business Mailing Address
First Line	:	2012 S TOLLGATE RD STE 207
Second Line	:
City	:	BEL AIR
State	:	MD
Zip	:	21015-5902
Country	:	US
Telephone Number	:	443-371-9750
Fax Number	:

Provider Business Practice Location Address
First Line	:	2012 S TOLLGATE RD
Second Line	:	SUITE 206
City	:	BEL AIR
State	:	MD
Zip	:	21015-5900
Country	:	US
Telephone Number	:	443-977-9180
Fax Number	:

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	07/12/2019

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