Healthcare Provider Details

I. General information

NPI: 1912240201
Provider Name (Legal Business Name): JENNIFER EZIRIKE LADIPO M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27700 NORTHWEST FWY STE 355
CYPRESS TX
77433-7749
US

IV. Provider business mailing address

3023 HAMAKER CT STE 600
FAIRFAX VA
22031-2241
US

V. Phone/Fax

Practice location:
  • Phone: 812-456-4575
  • Fax: 812-940-2665
Mailing address:
  • Phone: 703-876-2788
  • Fax: 703-839-8760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberC1-0012984
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD81212
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number0101270705
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberS6834
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: