Healthcare Provider Details

I. General information

NPI: 1689637662
Provider Name (Legal Business Name): PETER UKPEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 BAYBERRY LN
POUGHKEEPSIE NY
12603-4924
US

IV. Provider business mailing address

8 BAYBERRY LN
POUGHKEEPSIE NY
12603-4924
US

V. Phone/Fax

Practice location:
  • Phone: 202-713-5672
  • Fax:
Mailing address:
  • Phone: 202-713-5672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number196664
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: