NPIMap

Organization Active NPI

Chukwuma Ebo,M.D.,PA

  • Internal Medicine Physician
  • Baltimore, MD
National Provider Identifier
1043541253
Registry record updated Jan 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D0061907 Issued in MD
Legal business name
CHUKWUMA EBO,M.D.,PA
Practice address
1124 Mace Ave
Baltimore, MD 21221-3315
Phone
(410) 391-6996
Fax
(410) 687-6877
NPI assigned
Jan 28, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Chuwuma Ebo
Title
President
Phone
(410) 391-6996

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X D0061907 MD Primary

Addresses

Primary practice location

1124 Mace Ave
Baltimore, MD 21221-3315

Mailing address

1124 Mace Ave
Baltimore, MD 21221-3315
Phone (410) 391-6996

Other identifiers 1

IdentifierTypeStateIssuer
407505600MedicaidMD

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1264636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264636800000",
    "number": "1043541253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1124 MACE AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212213315",
            "telephone_number": "410-391-6996",
            "fax_number": "410-687-6877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 MACE AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212213315",
            "telephone_number": "410-391-6996",
            "fax_number": "410-687-6877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHUKWUMA EBO,M.D.,PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-28",
        "last_updated": "2010-01-28",
        "status": "A",
        "authorized_official_last_name": "EBO",
        "authorized_official_first_name": "CHUWUMA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "410-391-6996",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0061907",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "407505600",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.