Healthcare Provider Details

I. General information

NPI: 1356634109
Provider Name (Legal Business Name): ADA EGBUJI MD, MSPH, FACOEM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86TH MEDICAL GROUP
RAMSTEIN AB
09094
DE

IV. Provider business mailing address

PSC 2 BOX 1021
APO AE
09012
US

V. Phone/Fax

Practice location:
  • Phone: 637-146-2609
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number17340
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number17340
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number301492
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: