Provider Demographics
NPI:1801386453
Name:UGBODE, FRANKLIN IKECHUKWU (MD)
Entity Type:Individual
Prefix:
First Name:FRANKLIN
Middle Name:IKECHUKWU
Last Name:UGBODE
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 1:25 N LANSDOWNE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-2205
Mailing Address - Country:US
Mailing Address - Phone:631-268-5644
Mailing Address - Fax:
Practice Address - Street 1:857 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:PENN VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19072-1541
Practice Address - Country:US
Practice Address - Phone:661-664-2951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD474680207R00000X, 207RG0300X
DEC1-0025499207R00000X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program