Provider Demographics
NPI:1497998819
Name:AGUEH MCCRACKEN, MODUPE V (MD, MPH)
Entity Type:Individual
Prefix:MRS
First Name:MODUPE
Middle Name:V
Last Name:AGUEH MCCRACKEN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:MS
Other - First Name:MODUPE
Other - Middle Name:V
Other - Last Name:AGUEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:600 N. WOLFE STREET
Mailing Address - Street 2:PHIPPS 254
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287
Mailing Address - Country:US
Mailing Address - Phone:410-955-9045
Mailing Address - Fax:410-502-5505
Practice Address - Street 1:10755 FALLS RD
Practice Address - Street 2:SUITE 420
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4515
Practice Address - Country:US
Practice Address - Phone:443-997-0400
Practice Address - Fax:410-583-2756
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD077211207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology