Provider Demographics
NPI:1396735262
Name:UKOH, ALEXANDER EGWUATU J (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:EGWUATU J
Last Name:UKOH
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 1:4404 QUEENSBURY RD
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1068
Mailing Address - Country:US
Mailing Address - Phone:301-927-1800
Mailing Address - Fax:301-927-4020
Practice Address - Street 1:4404 QUEENSBURY RD
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1068
Practice Address - Country:US
Practice Address - Phone:301-927-1800
Practice Address - Fax:301-927-4020
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0048077208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB95091Medicare UPIN
MDKP95L225Medicare ID - Type Unspecified