MEDICARE: FRANKLIN IKECHUKWU UGBODE 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	207R00000X	Internal Medicine Physician	MD474680	PA
2	207R00000X	Internal Medicine Physician	C1-0025499	DE
3	390200000X	Student in an Organized Health Care Education/Training Program		NY
4	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	MD474680	PA

General Provider Information

NPI Number	:	1801386453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANKLIN IKECHUKWU UGBODE MD

Provider Business Mailing Address
First Line	:	25 N LANSDOWNE AVE
Second Line	:
City	:	LANSDOWNE
State	:	PA
Zip	:	19050-2205
Country	:	US
Telephone Number	:	631-268-5644
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 N LANSDOWNE AVE
Second Line	:
City	:	LANSDOWNE
State	:	PA
Zip	:	19050-2205
Country	:	US
Telephone Number	:	631-268-5644
Fax Number	:

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

Provider Enumeration Date	:	05/18/2018
Last Update Date	:	05/05/2025

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