Provider Demographics
NPI:1255304788
Name:ODUNUKWE, EBUBE EJIKE (MD)
Entity Type:Individual
Prefix:DR
First Name:EBUBE
Middle Name:EJIKE
Last Name:ODUNUKWE
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 1:7310 RITCHIE HWY.
Mailing Address - Street 2:SUITE #519
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3106
Mailing Address - Country:US
Mailing Address - Phone:410-760-1213
Mailing Address - Fax:410-760-1213
Practice Address - Street 1:7310 RITCHIE HWY.
Practice Address - Street 2:SUITE #519
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3106
Practice Address - Country:US
Practice Address - Phone:410-760-1213
Practice Address - Fax:410-760-1213
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0037074174400000X
MDD37074207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD293961400Medicaid
A59908Medicare UPIN