Provider Demographics
NPI:1275524944
Name:UDEZULU, IFEANYI AFAM (MD)
Entity Type:Individual
Prefix:DR
First Name:IFEANYI
Middle Name:AFAM
Last Name:UDEZULU
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 1:2720 FAST LANDING RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3105
Mailing Address - Country:US
Mailing Address - Phone:302-632-7610
Mailing Address - Fax:302-736-1047
Practice Address - Street 1:1019 MATTLIND WAY
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-5369
Practice Address - Country:US
Practice Address - Phone:302-424-1000
Practice Address - Fax:866-662-5282
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0007397207R00000X
VA0101236560207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010114578Medicaid
VA010114578Medicaid