Healthcare Provider Details

I. General information

NPI: 1316190598
Provider Name (Legal Business Name): AFAMEFUNA IMMANUEL UKETUI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 10/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 GEORGIA AVE NW
WASHINGTON DC
20001-2201
US

IV. Provider business mailing address

14437 GENERAL WASHINGTON DR
WOODBRIDGE VA
22193-3254
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: