Provider Demographics
NPI:1649667940
Name:IBE, ULOMA C (MD)
Entity type:Individual
Prefix:
First Name:ULOMA
Middle Name:C
Last Name:IBE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ULOMA
Other - Middle Name:
Other - Last Name:EMMA-EBERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 27996
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2031
Mailing Address - Country:US
Mailing Address - Phone:301-615-4133
Mailing Address - Fax:240-245-2918
Practice Address - Street 1:9500 MEDICAL CENTER DR STE 105
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-3703
Practice Address - Country:US
Practice Address - Phone:301-615-4133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0084916207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program