Provider Demographics
NPI:1346690187
Name:NDOLO, JOSEPHINE MWIKALI (MBCHB)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:MWIKALI
Last Name:NDOLO
Suffix:
Gender:F
Credentials:MBCHB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 FRANKLIN ST SE
Mailing Address - Street 2:STE 200
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4537
Mailing Address - Country:US
Mailing Address - Phone:256-539-0457
Mailing Address - Fax:256-539-5827
Practice Address - Street 1:2006 FRANKLIN ST SE STE 200
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4537
Practice Address - Country:US
Practice Address - Phone:256-539-0457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2023-08-09
Deactivation Date:2017-02-02
Deactivation Code:
Reactivation Date:2017-02-22
Provider Licenses
StateLicense IDTaxonomies
ALMD.407702085R0202X
TN616092085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL254057Medicaid
AL512-47085OtherBCBS
AL512-47832OtherBCBS
AL253348Medicaid
AL253365Medicaid
AL253907Medicaid
AL512-47830OtherBCBS
AL253370Medicaid
AL253981Medicaid
AL255559Medicaid
AL512-47835OtherBCBS
AL254056Medicaid
14653245OtherCAQH
AL253494Medicaid
AL253987Medicaid
AL512-47834OtherBCBS
AL253569Medicaid
AL253604Medicaid
AL264265Medicaid
AL512-47829OtherBCBS
AL253222Medicaid
AL253334Medicaid
AL264278Medicaid