Provider Demographics
NPI:1215590765
Name:ODUOK, UMOH SAMUEL
Entity Type:Individual
Prefix:
First Name:UMOH
Middle Name:SAMUEL
Last Name:ODUOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3312 TRELLIS LN
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-2878
Mailing Address - Country:US
Mailing Address - Phone:410-652-9496
Mailing Address - Fax:
Practice Address - Street 1:3312 TRELLIS LN
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-2878
Practice Address - Country:US
Practice Address - Phone:410-652-9496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD164861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD16486Medicaid