Provider Demographics
NPI:1104006360
Name:UNEGBU, UZOCHUKWU WILFRED (MD)
Entity Type:Individual
Prefix:DR
First Name:UZOCHUKWU
Middle Name:WILFRED
Last Name:UNEGBU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7350 VAN DUSEN RD
Mailing Address - Street 2:SUITE 390
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5263
Mailing Address - Country:US
Mailing Address - Phone:301-604-8000
Mailing Address - Fax:301-604-4406
Practice Address - Street 1:7350 VAN DUSEN RD
Practice Address - Street 2:SUITE 390
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5263
Practice Address - Country:US
Practice Address - Phone:301-604-8000
Practice Address - Fax:301-604-4406
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD71264207Q00000X
DCMD039026207Q00000X
VA0101247070207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine