Healthcare Provider Details

I. General information

NPI: 1447786041
Provider Name (Legal Business Name): CHINENYE OKUDOH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

110 S. PACA ST. 6TH FLOOR , SUITE 200
BALTIMORE MD
21201
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-3100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0107336
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-16-19032
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: