Healthcare Provider Details

I. General information

NPI: 1073929360
Provider Name (Legal Business Name): LAURA UWAKWE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 N BROAD ST
PHILADELPHIA PA
19102-1121
US

IV. Provider business mailing address

2101 CHESTNUT ST APT 2U
PHILADELPHIA PA
19103-3108
US

V. Phone/Fax

Practice location:
  • Phone: 917-388-0396
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number298161
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2018-00253
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: