Basic Information
| Provider Information | |||||||||
| NPI: | 1154081420 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | UDE | ||||||||
| FirstName: | ONYEDIKACHI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6430 SKYWARD CT | ||||||||
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| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210454447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019439701 | ||||||||
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| Practice Location | |||||||||
| Address1: | 757 FREDERICK RD STE 103 | ||||||||
| Address2: | |||||||||
| City: | CATONSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212284520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107198661 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2021 | ||||||||
| LastUpdateDate: | 12/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 28792 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.