Provider Demographics
NPI:1104278118
Name:DIKE, IKECHI (NP-C)
Entity type:Individual
Prefix:
First Name:IKECHI
Middle Name:
Last Name:DIKE
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 PULASKI HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-3625
Mailing Address - Country:US
Mailing Address - Phone:410-593-7556
Mailing Address - Fax:
Practice Address - Street 1:413 PULASKI HWY STE 201
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085
Practice Address - Country:US
Practice Address - Phone:410-593-7556
Practice Address - Fax:410-510-7958
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC002606363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner