Healthcare Provider Details

I. General information

NPI: 1861011702
Provider Name (Legal Business Name): IFEOMA NNENNA UDE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 05/25/2024
Certification Date: 05/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8136 OLD KEENE MILL RD STE B300
WEST SPRINGFIELD VA
22152-1856
US

IV. Provider business mailing address

8136 OLD KEENE MILL RD STE B300
WEST SPRINGFIELD VA
22152-1856
US

V. Phone/Fax

Practice location:
  • Phone: 703-451-6111
  • Fax:
Mailing address:
  • Phone: 703-451-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101281072
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: