Provider Demographics
NPI:1952580821
Name:UDOCHI, NJIDE (MD)
Entity Type:Individual
Prefix:
First Name:NJIDE
Middle Name:
Last Name:UDOCHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6310 STEVENS FOREST RD
Mailing Address - Street 2:STE 200
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2336
Mailing Address - Country:US
Mailing Address - Phone:410-740-9001
Mailing Address - Fax:410-313-9664
Practice Address - Street 1:6310 STEVENS FOREST RD
Practice Address - Street 2:STE 200
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2336
Practice Address - Country:US
Practice Address - Phone:410-740-9001
Practice Address - Fax:410-313-9664
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD005897207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD685900300Medicaid
MDH48267Medicare UPIN
DCG02158M01Medicare PIN
MD685900300Medicaid