MEDICARE: ALEXANDER EGWUATU J UKOH MD

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	208600000X	Surgery Physician	D0048077	MD

General Provider Information

NPI Number	:	1396735262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER EGWUATU J UKOH MD

Provider Business Mailing Address
First Line	:	4404 QUEENSBURY RD
Second Line	:
City	:	RIVERDALE
State	:	MD
Zip	:	20737-1068
Country	:	US
Telephone Number	:	301-927-1800
Fax Number	:	301-927-4020

Provider Business Practice Location Address
First Line	:	4404 QUEENSBURY RD
Second Line	:
City	:	RIVERDALE
State	:	MD
Zip	:	20737-1068
Country	:	US
Telephone Number	:	301-927-1800
Fax Number	:	301-927-4020

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	10/10/2007

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