=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205029600
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | UWADIOGBU ODINAKA EJINDU MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2007
-----------------------------------------------------
Last Update Date | 01/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7401 THE PLZ
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-817-8275
-----------------------------------------------------
Fax | 704-817-7630
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7401 THE PLZ
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28215-1925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-817-8275
-----------------------------------------------------
Fax | 704-817-7630
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 200701360
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------