Provider Demographics
NPI:1154081420
Name:UDE, ONYEDIKACHI
Entity Type:Individual
Prefix:
First Name:ONYEDIKACHI
Middle Name:
Last Name:UDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6430 SKYWARD CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-4447
Mailing Address - Country:US
Mailing Address - Phone:301-943-9701
Mailing Address - Fax:
Practice Address - Street 1:757 FREDERICK RD STE 103
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4520
Practice Address - Country:US
Practice Address - Phone:410-719-8661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-28
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28792225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist