Provider Demographics
NPI:1376502492
Name:EKONG, UDEME D (MD)
Entity Type:Individual
Prefix:DR
First Name:UDEME
Middle Name:D
Last Name:EKONG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 208064
Mailing Address - Street 2:DEPT OF PEDIATRIC GASTROENTEROLOGY RM 4093
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8064
Mailing Address - Country:US
Mailing Address - Phone:203-785-4649
Mailing Address - Fax:203-785-3365
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:YALE NEW HAVEN HOSPITAL
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-785-4649
Practice Address - Fax:203-785-3365
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2013-01-07
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Provider Licenses
StateLicense IDTaxonomies
IL0361102232080P0206X
CT0515292080T0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080T0004XAllopathic & Osteopathic PhysiciansPediatricsPediatric Transplant Hepatology
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036110223Medicaid
ILK12803Medicare ID - Type Unspecified
I21966Medicare UPIN