Provider Demographics
NPI:1720234560
Name:ORAZULIKE, EBELE GWENDOLYN (MD)
Entity Type:Individual
Prefix:
First Name:EBELE
Middle Name:GWENDOLYN
Last Name:ORAZULIKE
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 1:2214 OLD CHEROKEE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9725
Mailing Address - Country:US
Mailing Address - Phone:803-520-9380
Mailing Address - Fax:803-520-5972
Practice Address - Street 1:342 PATRICIA LANE
Practice Address - Street 2:STE 105
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708
Practice Address - Country:US
Practice Address - Phone:803-520-9380
Practice Address - Fax:803-520-5972
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201101644208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC514526Medicaid
NC5921816Medicaid