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General NPI Number Information
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NPI Number | 1497904973
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Entity Type | Individual
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Provider Name | JUSTINA EGBICHI EKE M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/09/2008
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Last Update Date | 01/26/2012
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Provider Practice Location Address
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Address Line | 1804 W KING STREET 200
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City | MARTINSBURG
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State | WV
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Zip | 25401-2004
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Country | US
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Telephone | 304-262-4525
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Fax | 304-262-4205
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Provider Business Mailing Address
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Address Line | 1804 W KING ST 200
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City | MARTINSBURG
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State | WV
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Zip | 25401-2004
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Country | US
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Telephone | 304-262-4525
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Fax | 304-262-4205
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 23370
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License Number State | WV
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