Provider Demographics
NPI:1326050634
Name:URADU, ROSE ONYINYECHI (MD)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:ONYINYECHI
Last Name:URADU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CAMDEN RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-2708
Mailing Address - Country:US
Mailing Address - Phone:606-393-4632
Mailing Address - Fax:888-411-4131
Practice Address - Street 1:3655 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7739
Practice Address - Country:US
Practice Address - Phone:606-393-4632
Practice Address - Fax:888-411-4131
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40541207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I63400Medicare UPIN