Provider Demographics
NPI:1255442851
Name:UDO, NKEREUWEM
Entity type:Individual
Prefix:
First Name:NKEREUWEM
Middle Name:
Last Name:UDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6475 NEW HAMPSHIRE AVE
Mailing Address - Street 2:SUITE.305
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3269
Mailing Address - Country:US
Mailing Address - Phone:301-270-0655
Mailing Address - Fax:301-270-0606
Practice Address - Street 1:13927 WESTVIEW FOREST DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-4866
Practice Address - Country:US
Practice Address - Phone:301-262-6156
Practice Address - Fax:301-270-0606
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies