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General NPI Number Information
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NPI Number | 1689942187
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Entity Type | Organization
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Legal Business Name | EBUBE E.ODUNUKWE, M.D.,P.C.
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Dates
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Enumeration Date | 12/12/2011
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Last Update Date | 12/12/2011
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Provider Practice Location Address
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Address Line | 7310 RITCHIE HWY STE 519
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City | GLEN BURNIE
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State | MD
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Zip | 21061-3099
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Country | US
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Telephone | 410-760-1213
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Fax |
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Provider Business Mailing Address
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Address Line | 7310 RITCHIE HWY. # 519
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City | GLEN BURNIE
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State | MD
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Zip | 21061-3099
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Country | US
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Telephone | 410-760-1213
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | EBUBE ODUNUKWE
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Credential | M.D.
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Telephone | 410-760-1213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | D0037074
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License Number State | MD
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