Provider Demographics
NPI:1336283720
Name:ONWUEME, KENOLISA C (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:KENOLISA
Middle Name:C
Last Name:ONWUEME
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
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Mailing Address - Street 1:1838 GREENE TREE RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6391
Mailing Address - Country:US
Mailing Address - Phone:410-602-7782
Mailing Address - Fax:410-602-2438
Practice Address - Street 1:1838 GREENE TREE RD
Practice Address - Street 2:SUITE 400
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-6391
Practice Address - Country:US
Practice Address - Phone:410-602-7782
Practice Address - Fax:410-602-2438
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2013-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA229454207R00000X
MDD0069402207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD168850ZB1RMedicare PIN