Healthcare Provider Details

I. General information

NPI: 1689942187
Provider Name (Legal Business Name): EBUBE E.ODUNUKWE, M.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7310 RITCHIE HWY STE 519
GLEN BURNIE MD
21061-3099
US

IV. Provider business mailing address

7310 RITCHIE HWY. # 519
GLEN BURNIE MD
21061-3099
US

V. Phone/Fax

Practice location:
  • Phone: 410-760-1213
  • Fax:
Mailing address:
  • Phone: 410-760-1213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberD0037074
License Number StateMD

VIII. Authorized Official

Name: EBUBE ODUNUKWE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 410-760-1213