Provider Demographics
NPI:1336959329
Name:UDEMBA, ONYEKA VICTOR
Entity type:Individual
Prefix:
First Name:ONYEKA
Middle Name:VICTOR
Last Name:UDEMBA
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 1:17203 BROOKMEADOW LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-3304
Mailing Address - Country:US
Mailing Address - Phone:240-422-0448
Mailing Address - Fax:
Practice Address - Street 1:17203 BROOKMEADOW LN
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3304
Practice Address - Country:US
Practice Address - Phone:240-422-0448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator