Healthcare Provider Details

I. General information

NPI: 1801386453
Provider Name (Legal Business Name): FRANKLIN IKECHUKWU UGBODE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N LANSDOWNE AVE
LANSDOWNE PA
19050-2205
US

IV. Provider business mailing address

25 N LANSDOWNE AVE
LANSDOWNE PA
19050-2205
US

V. Phone/Fax

Practice location:
  • Phone: 631-268-5644
  • Fax:
Mailing address:
  • Phone: 631-268-5644
  • 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 StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD474680
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC1-0025499
License Number StateDE
# 4
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD474680
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: