Provider Demographics
NPI:1477120590
Name:UDUEBOR, MIRIAM IBHADE (MD)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:IBHADE
Last Name:UDUEBOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5758
Mailing Address - Country:US
Mailing Address - Phone:207-626-7400
Mailing Address - Fax:207-626-7401
Practice Address - Street 1:6 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5758
Practice Address - Country:US
Practice Address - Phone:207-626-7400
Practice Address - Fax:207-626-7401
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEEC211071390200000X
MEMD24835207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program