Provider Demographics
NPI:1811032253
Name:UCHENNA UZOUKWU, MD LLC
Entity Type:Organization
Organization Name:UCHENNA UZOUKWU, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:UCHENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:UZOUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-621-5015
Mailing Address - Street 1:PO BOX 561
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-0561
Mailing Address - Country:US
Mailing Address - Phone:570-621-5015
Mailing Address - Fax:570-621-9888
Practice Address - Street 1:121 PROGRESS AVE FL 2
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-2968
Practice Address - Country:US
Practice Address - Phone:570-621-5015
Practice Address - Fax:570-621-5858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD059079L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015888550001Medicaid
PA1015888550001Medicaid
PA1015888550001Medicaid
PA097073Medicare PIN