Provider Demographics
NPI:1619167202
Name:EZUMBA, IKENNA I (MD)
Entity Type:Individual
Prefix:
First Name:IKENNA
Middle Name:I
Last Name:EZUMBA
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 1:826 WASHINGTON RD STE 205
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5780
Mailing Address - Country:US
Mailing Address - Phone:410-386-9099
Mailing Address - Fax:410-386-9098
Practice Address - Street 1:826 WASHINGTON RD STE 205
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5780
Practice Address - Country:US
Practice Address - Phone:410-386-9099
Practice Address - Fax:410-386-9098
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND10655207R00000X
MDD0066394207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine