Basic Information
| Provider Information | |||||||||
| NPI: | 1851641575 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NDUBISI | ||||||||
| FirstName: | UCHENNA | ||||||||
| MiddleName: | UZOMA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10750 COLUMBIA PIKE | ||||||||
| Address2: | SUITE 401B | ||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209014457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015921500 | ||||||||
| FaxNumber: | 3015921506 | ||||||||
| Practice Location | |||||||||
| Address1: | 4321 HARTWICK RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | COLLEGE PARK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207403210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012776616 | ||||||||
| FaxNumber: | 3012776618 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2012 | ||||||||
| LastUpdateDate: | 03/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 24180 | MD | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 225100000X | 24180 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.