Provider Demographics
NPI:1497904973
Name:EKE, JUSTINA EGBICHI (MD)
Entity Type:Individual
Prefix:
First Name:JUSTINA
Middle Name:EGBICHI
Last Name:EKE
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 1:1804 W KING ST
Mailing Address - Street 2:200
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2004
Mailing Address - Country:US
Mailing Address - Phone:304-262-4525
Mailing Address - Fax:304-262-4205
Practice Address - Street 1:1804 W KING STREET
Practice Address - Street 2:200
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2004
Practice Address - Country:US
Practice Address - Phone:304-262-4525
Practice Address - Fax:304-262-4205
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23370208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics