Healthcare Provider Details

I. General information

NPI: 1225305840
Provider Name (Legal Business Name): JOSEPH ONUKWUFOR UDEH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7661 WOODPARK LN APT 303
COLUMBIA MD
21046-2736
US

IV. Provider business mailing address

7661 WOODPARK LN APT 303
COLUMBIA MD
21046-2736
US

V. Phone/Fax

Practice location:
  • Phone: 301-254-8155
  • Fax:
Mailing address:
  • Phone: 301-254-8155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR159606
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: