MEDICARE: ULOMA C IBE 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	207Q00000X	Family Medicine Physician	D0084916	MD

General Provider Information

NPI Number	:	1649667940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ULOMA C IBE MD

Provider Business Mailing Address
First Line	:	PO BOX 27996
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-2031
Country	:	US
Telephone Number	:	301-615-4133
Fax Number	:	240-245-2918

Provider Business Practice Location Address
First Line	:	9500 MEDICAL CENTER DR STE 105
Second Line	:
City	:	LARGO
State	:	MD
Zip	:	20774-3703
Country	:	US
Telephone Number	:	301-615-4133
Fax Number	:

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

Provider Enumeration Date	:	04/24/2015
Last Update Date	:	06/01/2021

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