Provider Demographics
NPI:1114362902
Name:EKO, CHARITY U (MD MPH MBA)
Entity Type:Individual
Prefix:DR
First Name:CHARITY
Middle Name:U
Last Name:EKO
Suffix:
Gender:F
Credentials:MD MPH MBA
Other - Prefix:
Other - First Name:UMO
Other - Middle Name:UMO
Other - Last Name:IYANAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:815 S WASHINGTON AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-5358
Mailing Address - Country:US
Mailing Address - Phone:903-934-5600
Mailing Address - Fax:
Practice Address - Street 1:815 S WASHINGTON AVE STE 303
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-5358
Practice Address - Country:US
Practice Address - Phone:903-934-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS0870207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX40051201Medicaid
TX829953OtherMEDICARE