MEDICARE: UDODIRI JUDE ONWUBIKO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R220008	MD

General Provider Information

NPI Number	:	1265160162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	UDODIRI JUDE ONWUBIKO

Provider Business Mailing Address
First Line	:	9500 PAINTED TREE DR
Second Line	:
City	:	RANDALLSTOWN
State	:	MD
Zip	:	21133-2845
Country	:	US
Telephone Number	:	443-615-3396
Fax Number	:

Provider Business Practice Location Address
First Line	:	218 E LEXINGTON ST STE 303
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21202-3538
Country	:	US
Telephone Number	:	443-615-3396
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2022
Last Update Date	:	08/21/2023

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