Provider Demographics
NPI:1821179243
Name:UDDOH, CORDELIA NKOLIKA (MD)
Entity type:Individual
Prefix:
First Name:CORDELIA
Middle Name:NKOLIKA
Last Name:UDDOH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 539
Mailing Address - Street 2:608 EASTON ROAD SUITE C
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-0539
Mailing Address - Country:US
Mailing Address - Phone:215-657-5044
Mailing Address - Fax:215-657-5046
Practice Address - Street 1:3212 W CHELTENHAM AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-1003
Practice Address - Country:US
Practice Address - Phone:215-657-5044
Practice Address - Fax:215-657-5046
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD069007L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01772773Medicaid
187976YBOQOtherMEDICARE
H04869Medicare UPIN