Provider Demographics
NPI:1447231626
Name:UGWANYI, EBERE MAXWELL (MD)
Entity Type:Individual
Prefix:
First Name:EBERE
Middle Name:MAXWELL
Last Name:UGWANYI
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 1:329 S PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-2262
Mailing Address - Country:US
Mailing Address - Phone:814-443-5172
Mailing Address - Fax:814-443-5697
Practice Address - Street 1:126 E CHURCH ST STE 3100
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2274
Practice Address - Country:US
Practice Address - Phone:814-445-7101
Practice Address - Fax:814-445-7688
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD468730207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
207RC0000XOtherTAXONOMY CODE
OH2836506Medicaid
207RC0000XOtherTAXONOMY CODE
207RC0000XOtherTAXONOMY CODE
OH4237541OtherMEDICARE NUMBER
OHUG4237541Medicare PIN