Provider Demographics
NPI:1548232523
Name:UFONDU, SOLIBE CHIKAODILI (MD)
Entity Type:Individual
Prefix:
First Name:SOLIBE
Middle Name:CHIKAODILI
Last Name:UFONDU
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 1:302 E BROWN ST
Mailing Address - Street 2:STE A
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3010
Mailing Address - Country:US
Mailing Address - Phone:570-476-4161
Mailing Address - Fax:570-476-9808
Practice Address - Street 1:302 E BROWN ST
Practice Address - Street 2:STE A
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301
Practice Address - Country:US
Practice Address - Phone:570-476-4161
Practice Address - Fax:570-476-9954
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD062479L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017527430004Medicaid
PA026781Medicare ID - Type Unspecified
G38408Medicare UPIN