Provider Demographics
NPI:1225305840
Name:UDEH, JOSEPH ONUKWUFOR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ONUKWUFOR
Last Name:UDEH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7661 WOODPARK LN APT 303
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2736
Mailing Address - Country:US
Mailing Address - Phone:301-254-8155
Mailing Address - Fax:
Practice Address - Street 1:7661 WOODPARK LN APT 303
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2736
Practice Address - Country:US
Practice Address - Phone:301-254-8155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR159606367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered