Provider Demographics
NPI:1578540860
Name:UBA, DANIEL CHIDI (MD/INTERNAL MEDICINE)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:CHIDI
Last Name:UBA
Suffix:
Gender:M
Credentials:MD/INTERNAL MEDICINE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 SKIBO RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1518
Mailing Address - Country:US
Mailing Address - Phone:910-864-4357
Mailing Address - Fax:910-221-0099
Practice Address - Street 1:1905 SKIBO ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-1523
Practice Address - Country:US
Practice Address - Phone:910-864-4357
Practice Address - Fax:910-221-0099
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100099207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC200100099OtherMEDICAL LISCENSE #
NC89129MGMedicaid
NC200100099OtherMEDICAL LISCENSE #
NC89129MGMedicaid