Provider Demographics
NPI:1881630846
Name:IMOISILI, ULUMENFO (MD)
Entity Type:Individual
Prefix:DR
First Name:ULUMENFO
Middle Name:
Last Name:IMOISILI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MENFO
Other - Middle Name:
Other - Last Name:IMOISILI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8348 KINGS HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6051
Mailing Address - Country:US
Mailing Address - Phone:410-465-6917
Mailing Address - Fax:
Practice Address - Street 1:7300 VAN DUSEN RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-9266
Practice Address - Country:US
Practice Address - Phone:301-725-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0038524208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics