Healthcare Provider Details

I. General information

NPI: 1649667940
Provider Name (Legal Business Name): ULOMA C IBE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ULOMA EMMA-EBERE MD

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 MEDICAL CENTER DR STE 105
LARGO MD
20774-3703
US

IV. Provider business mailing address

PO BOX 27996
BELFAST ME
04915-2031
US

V. Phone/Fax

Practice location:
  • Phone: 301-615-4133
  • Fax:
Mailing address:
  • Phone: 301-615-4133
  • Fax: 240-245-2918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0084916
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: