Provider Demographics
NPI:1780773010
Name:DAGADU, EPHRAIM E (MD)
Entity type:Individual
Prefix:DR
First Name:EPHRAIM
Middle Name:E
Last Name:DAGADU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9832-F YORK ROAD
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-4936
Mailing Address - Country:US
Mailing Address - Phone:410-628-1861
Mailing Address - Fax:410-628-1862
Practice Address - Street 1:9832 YORK ROAD
Practice Address - Street 2:SUITE F
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-4936
Practice Address - Country:US
Practice Address - Phone:410-628-1861
Practice Address - Fax:410-628-1862
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD32012207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC48799Medicare UPIN