MEDICARE: ANCA UDREA MD, LTD

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

General Provider Information

NPI Number	:	1801849930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANCA UDREA MD, LTD

Provider Business Mailing Address
First Line	:	2600 FAR HILLS AVE
Second Line	:	STE 216
City	:	KETTERING
State	:	OH
Zip	:	45419-1602
Country	:	US
Telephone Number	:	937-299-2441
Fax Number	:	937-299-2447

Provider Business Practice Location Address
First Line	:	2600 FAR HILLS AVE
Second Line	:	STE 216
City	:	KETTERING
State	:	OH
Zip	:	45419-1602
Country	:	US
Telephone Number	:	937-299-2441
Fax Number	:	937-299-2447

Authorized Official
Title or Position	:	OWNER
Name	:	ANCA UDREA
Credential	:	MD
Telephone Number	:	937-299-2441

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	04/17/2008

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