MEDICARE: GEORGE C EGO-OSUALA MD., FACP

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	207R00000X	Internal Medicine Physician	D 47156	MD
2	207R00000X	Internal Medicine Physician	MD 21355	DC
3	208D00000X	General Practice Physician	D 47156	MD
4	208D00000X	General Practice Physician	MD 21355	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679578835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE C EGO-OSUALA MD., FACP

Provider Business Mailing Address
First Line	:	PO BOX 7909
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20787-7909
Country	:	US
Telephone Number	:	301-434-9147
Fax Number	:	301-434-9178

Provider Business Practice Location Address
First Line	:	7676 NEW HAMPSHIRE AVE
Second Line	:	STE 420
City	:	TAKOMA PARK
State	:	MD
Zip	:	20912-7516
Country	:	US
Telephone Number	:	301-434-9147
Fax Number	:	301-434-9178

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	05/13/2008

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Directions to “ GEORGE C EGO-OSUALA MD., FACP” Practice Location

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