Provider Demographics
NPI:1689942187
Name:EBUBE E.ODUNUKWE, M.D.,P.C.
Entity Type:Organization
Organization Name:EBUBE E.ODUNUKWE, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EBUBE
Authorized Official - Middle Name:
Authorized Official - Last Name:ODUNUKWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-760-1213
Mailing Address - Street 1:7310 RITCHIE HWY. # 519
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3099
Mailing Address - Country:US
Mailing Address - Phone:410-760-1213
Mailing Address - Fax:
Practice Address - Street 1:7310 RITCHIE HWY STE 519
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3099
Practice Address - Country:US
Practice Address - Phone:410-760-1213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0037074261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD293961400Medicaid
A59908Medicare UPIN
6514Medicare PIN