Basic Information
| Provider Information | |||||||||
| NPI: | 1487880373 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | UDEKWU | ||||||||
| FirstName: | ADAORA | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | IKEDILO | ||||||||
| OtherFirstName: | ADAORA | ||||||||
| OtherMiddleName: | S | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 110 W 6TH ST | ||||||||
| Address2: | |||||||||
| City: | OSWEGO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 131262507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153495733 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 110 W 6TH ST | ||||||||
| Address2: | |||||||||
| City: | OSWEGO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 131262507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153495733 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2009 | ||||||||
| LastUpdateDate: | 12/09/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | E-8971 | AR | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208M00000X | 282451 | NY | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.