Healthcare Provider Details

I. General information

NPI: 1326050634
Provider Name (Legal Business Name): ROSE ONYINYECHI URADU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3655 WINCHESTER AVE
ASHLAND KY
41101-7739
US

IV. Provider business mailing address

401 CAMDEN RD
HUNTINGTON WV
25704-2708
US

V. Phone/Fax

Practice location:
  • Phone: 606-393-4632
  • Fax: 888-411-4131
Mailing address:
  • Phone: 606-393-4632
  • Fax: 888-411-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number40541
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number40541
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: