Provider Demographics
NPI:1700847480
Name:UNDIE, AMAKA J (MD)
Entity Type:Individual
Prefix:
First Name:AMAKA
Middle Name:J
Last Name:UNDIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:10300 BALTIMORE NATIONAL PIKE
Mailing Address - Street 2:A
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2128
Mailing Address - Country:US
Mailing Address - Phone:410-465-7337
Mailing Address - Fax:410-465-1620
Practice Address - Street 1:10300 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:A
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-2128
Practice Address - Country:US
Practice Address - Phone:410-465-7337
Practice Address - Fax:410-465-1620
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2015-03-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0048078208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF42434Medicare UPIN