Healthcare Provider Details

I. General information

NPI: 1952384992
Provider Name (Legal Business Name): RALPH E UPDIKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 WILKENS AVE STE 301
BALTIMORE MD
21229-4845
US

IV. Provider business mailing address

4660 WILKENS AVE STE 301
BALTIMORE MD
21229-4845
US

V. Phone/Fax

Practice location:
  • Phone: 410-646-4404
  • Fax: 410-525-1166
Mailing address:
  • Phone: 410-646-4404
  • Fax: 410-525-1166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD10941
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: