Provider Demographics
NPI:1972557387
Name:UMEH, ONUORAH IKE (MD)
Entity Type:Individual
Prefix:DR
First Name:ONUORAH
Middle Name:IKE
Last Name:UMEH
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 1:4237 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4411
Mailing Address - Country:US
Mailing Address - Phone:215-382-1040
Mailing Address - Fax:215-382-1047
Practice Address - Street 1:4237 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4411
Practice Address - Country:US
Practice Address - Phone:215-382-1040
Practice Address - Fax:215-382-1047
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039262-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01063856Medicaid
PA01063856Medicaid