Provider Demographics
NPI:1457412736
Name:UDEZUE, ADAEZE (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAEZE
Middle Name:
Last Name:UDEZUE
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:PO BOX 1205
Mailing Address - Street 2:
Mailing Address - City:OCEAN VIEW
Mailing Address - State:DE
Mailing Address - Zip Code:19970-1205
Mailing Address - Country:US
Mailing Address - Phone:302-933-3000
Mailing Address - Fax:302-934-1145
Practice Address - Street 1:26351 PATRIOTS WAY
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-2575
Practice Address - Country:US
Practice Address - Phone:302-933-3000
Practice Address - Fax:302-934-1145
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECI-0006825207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000022974Medicaid
H46750Medicare UPIN
491526Medicare ID - Type Unspecified