Healthcare Provider Details

I. General information

NPI: 1023249406
Provider Name (Legal Business Name): CHIEKE OKPORI UDOM M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2009
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 CONIFER HILL DR
DANVERS MA
01923-1193
US

IV. Provider business mailing address

147 S MAIN ST
MIDDLETON MA
01949-2446
US

V. Phone/Fax

Practice location:
  • Phone: 978-774-2555
  • Fax: 978-774-8715
Mailing address:
  • Phone: 978-774-2555
  • Fax: 978-774-8715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number248600
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number248600
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: