Provider Demographics
NPI:1952384992
Name:UPDIKE, RALPH E (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:E
Last Name:UPDIKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 WILKENS AVE
Mailing Address - Street 2:STE 301
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-4845
Mailing Address - Country:US
Mailing Address - Phone:410-646-4404
Mailing Address - Fax:410-525-1166
Practice Address - Street 1:4660 WILKENS AVE
Practice Address - Street 2:STE 301
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-4845
Practice Address - Country:US
Practice Address - Phone:410-646-4404
Practice Address - Fax:410-525-1166
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD10941207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD023571700Medicaid
MD023571700Medicaid
MDKN14116RMedicare PIN