Provider Demographics
NPI:1285802801
Name:NDUOM, EDJAH (MD)
Entity type:Individual
Prefix:
First Name:EDJAH
Middle Name:
Last Name:NDUOM
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 1:1365B CLIFTON RD NE
Mailing Address - Street 2:SUITE 6400
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 CENTER DR 10/3D20, MSC 1414
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-1013
Practice Address - Country:US
Practice Address - Phone:301-496-2921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-17
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002213207T00000X
GA85703207T00000X
TXP9918207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8EJ129 (MDACC)OtherBCBS
TX335993701 (MDACC)Medicaid
TX335993701 (MDACC)Medicaid