Healthcare Provider Details

I. General information

NPI: 1750556098
Provider Name (Legal Business Name): CHIDIEBERE UZOMA EKEOCHA M.D./MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 10/11/2020
Certification Date: 10/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 OSLER DR
TOWSON MD
21204-7700
US

IV. Provider business mailing address

4518 NECKER AVE
NOTTINGHAM MD
21236-2762
US

V. Phone/Fax

Practice location:
  • Phone: 410-337-1226
  • Fax:
Mailing address:
  • Phone: 410-428-4891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0073799
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: