MEDICARE: UKUAJI MEDICAL

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1427835875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UKUAJI MEDICAL

Provider Business Mailing Address
First Line	:	2214 OLD EMMORTON RD
Second Line	:
City	:	BEL AIR
State	:	MD
Zip	:	21015-6470
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2214 OLD EMMORTON RD STE 210
Second Line	:
City	:	BEL AIR
State	:	MD
Zip	:	21015-6470
Country	:	US
Telephone Number	:	443-402-1139
Fax Number	:	410-638-2489

Authorized Official
Title or Position	:	CREDENTIALING DIRECTOR
Name	:	CREDENTIALING DIRECTOR
Credential	:
Telephone Number	:	443-402-1139

Provider Enumeration Date	:	09/11/2023
Last Update Date	:	01/16/2024

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Directions to “UKUAJI MEDICAL ” Practice Location

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