Individual
EDJAH NDUOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10 CENTER DR 10/3D20, MSC 1414, BETHESDA, MD 20892-1013
(301) 496-2921
Mailing address
1365B CLIFTON RD NE, SUITE 6400, ATLANTA, GA 30322-1013
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
002213
GA
207T00000X
Neurological Surgery Physician
Primary
85703
GA
207T00000X
Neurological Surgery Physician
P9918
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
335993701 (MDACC)
—
TX
01
—
8EJ129 (MDACC)
BCBS
TX
Enumeration date
02/17/2008
Last updated
12/04/2020
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