Healthcare Provider Details

I. General information

NPI: 1275065849
Provider Name (Legal Business Name): OGOCHUKWU GIDEON UDORJI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: OGOCHUKWU UDORJI MD

II. Dates (important events)

Enumeration Date: 04/01/2017
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4465 CORDATA PKWY
BELLINGHAM WA
98226-8037
US

IV. Provider business mailing address

4439 STATE ROUTE 159 STE 150
CHILLICOTHEE OH
45601-7833
US

V. Phone/Fax

Practice location:
  • Phone: 360-752-5206
  • Fax: 360-752-5653
Mailing address:
  • Phone: 740-779-8268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number35146885
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD61079145
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: