MEDICARE: DR. EMMANUEL A ATIEMO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	M12927	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04970001	OTHER	DC	DC CAREFIRST

General Provider Information

NPI Number	:	1134178718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMMANUEL A ATIEMO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1400
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22038-1400
Country	:	US
Telephone Number	:	703-383-9543
Fax Number	:	703-383-9532

Provider Business Practice Location Address
First Line	:	4400 STAMP RD
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-6728
Country	:	US
Telephone Number	:	301-423-5494
Fax Number	:	301-423-0154

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	07/09/2007

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