Healthcare Provider Details

I. General information

NPI: 1013995877
Provider Name (Legal Business Name): AUDREY O PESSU-UWAH M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 THE GRN STUDENT HEALTH SERVICE LAUREL HALL UNIV. OF DELAWARE
NEWARK DE
19716-0009
US

IV. Provider business mailing address

259 BUCKTAIL DR
MIDDLETOWN DE
19709-6134
US

V. Phone/Fax

Practice location:
  • Phone: 302-831-2227
  • Fax: 302-831-6407
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC10005192
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: