Healthcare Provider Details

I. General information

NPI: 1740660679
Provider Name (Legal Business Name): OLUCHI DIKE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065A LOVING RD
SEVERN MD
21144-2536
US

IV. Provider business mailing address

1065A LOVING RD
SEVERN MD
21144-2536
US

V. Phone/Fax

Practice location:
  • Phone: 301-628-8182
  • Fax:
Mailing address:
  • Phone: 301-628-8182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD85480
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: