Provider Demographics
NPI:1770539389
Name:UDOH, MOSES E (MD)
Entity type:Individual
Prefix:DR
First Name:MOSES
Middle Name:E
Last Name:UDOH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:SC HOUSE CALLS INC
Mailing Address - Street 2:111 DOCTORS CIRCLE
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:800-491-0909
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:SC HOUSE CALLS INC
Practice Address - Street 2:111 DOCTORS CIRCLE
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:800-491-0909
Practice Address - Fax:803-774-9113
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2006-00889207R00000X
SC23185207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT74906Medicaid
SCT74906Medicaid
SC576007863071OtherBLUECHOICE HEALTHPLAN ID
SC9682984OtherCIGNA ID
SC7242417OtherAETNA ID
SC576007863071OtherBLUECHOICE HEALTHPLAN ID
SC9682984OtherCIGNA ID