MEDICARE: ONYEBUCHI MUDALUE

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	363LA2100X	Acute Care Nurse Practitioner	R223392	MD

General Provider Information

NPI Number	:	1578430260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ONYEBUCHI MUDALUE

Provider Business Mailing Address
First Line	:	6201 GREENLEIGH AVE
Second Line	:
City	:	MIDDLE RIVER
State	:	MD
Zip	:	21220-2004
Country	:	US
Telephone Number	:	410-933-0000
Fax Number	:	410-500-4266

Provider Business Practice Location Address
First Line	:	8512 POTOMAC CREEK RD
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20724-1988
Country	:	US
Telephone Number	:	301-317-8305
Fax Number	:

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

Provider Enumeration Date	:	10/20/2025
Last Update Date	:	03/20/2026

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Directions to “ ONYEBUCHI MUDALUE ” Practice Location

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