Provider Demographics
NPI:1821363722
Name:UKWU, HENRIETTA NGOZI (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRIETTA
Middle Name:NGOZI
Last Name:UKWU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 E BUTLER PIKE
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2817
Mailing Address - Country:US
Mailing Address - Phone:610-405-6055
Mailing Address - Fax:
Practice Address - Street 1:1810 E BUTLER PIKE
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-2817
Practice Address - Country:US
Practice Address - Phone:610-405-6055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049335L1744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study