Healthcare Provider Details

I. General information

NPI: 1093344459
Provider Name (Legal Business Name): CHISO ORI UKO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10005 OLD COLUMBIA RD STE P170
COLUMBIA MD
21046-1727
US

IV. Provider business mailing address

10005 OLD COLUMBIA RD STE P170
COLUMBIA MD
21046-1727
US

V. Phone/Fax

Practice location:
  • Phone: 410-312-5280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0008060
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: