Provider Demographics
NPI:1619113628
Name:ORISADELE, ADAKU UGOMMA (MD)
Entity Type:Individual
Prefix:
First Name:ADAKU
Middle Name:UGOMMA
Last Name:ORISADELE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ADAKU
Other - Middle Name:UGOMMA
Other - Last Name:NWOKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-1800
Mailing Address - Fax:717-851-1810
Practice Address - Street 1:1010 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-3864
Practice Address - Country:US
Practice Address - Phone:717-851-1800
Practice Address - Fax:717-851-1810
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-22
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD444924207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102677978Medicaid
PA234352Medicare PIN