MEDICARE: AMAKA J UNDIE 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	D0048078	MD

General Provider Information

NPI Number	:	1700847480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMAKA J UNDIE M.D

Provider Business Mailing Address
First Line	:	10300 BALTIMORE NATIONAL PIKE
Second Line	:	A
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-2128
Country	:	US
Telephone Number	:	410-465-7337
Fax Number	:	410-465-1620

Provider Business Practice Location Address
First Line	:	10300 BALTIMORE NATIONAL PIKE
Second Line	:	A
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-2128
Country	:	US
Telephone Number	:	410-465-7337
Fax Number	:	410-465-1620

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	03/02/2015

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