Healthcare Provider Details

I. General information

NPI: 1225152283
Provider Name (Legal Business Name): ADAORA NGOZI UDOH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 YOUNG AVE STE 325
MOORESTOWN NJ
08057
US

IV. Provider business mailing address

2000 CRAWFORD PL STE 200
MOUNT LAUREL NJ
08054-3954
US

V. Phone/Fax

Practice location:
  • Phone: 856-291-8865
  • Fax: 856-291-8880
Mailing address:
  • Phone: 856-355-0340
  • Fax: 856-355-0335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA08320400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: