Provider Demographics
NPI:1932962305
Name:EMELIKE, EMMANUEL KELECHI
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:KELECHI
Last Name:EMELIKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14110 DORMANSVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-9038
Mailing Address - Country:US
Mailing Address - Phone:240-615-6394
Mailing Address - Fax:
Practice Address - Street 1:14110 DORMANSVILLE BLVD
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-9038
Practice Address - Country:US
Practice Address - Phone:240-615-6394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD390200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program