Healthcare Provider Details

I. General information

NPI: 1578829081
Provider Name (Legal Business Name): UCHENNA JOHN ACHEBE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8450 DORSEY RUN RD
JESSUP MD
20794-9486
US

IV. Provider business mailing address

701 W PRATT ST 4TH FLOOR
BALTIMORE MD
21201-1023
US

V. Phone/Fax

Practice location:
  • Phone: 410-724-3210
  • Fax:
Mailing address:
  • Phone: 410-328-5076
  • Fax: 410-328-1212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: