Healthcare Provider Details

I. General information

NPI: 1609703966
Provider Name (Legal Business Name): PETER OJUGACHE CHENYUEIKOH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4645 NANNIE HELEN BURROUGHS AVE NE
WASHINGTON DC
20019-3622
US

IV. Provider business mailing address

9202 AMBER OAKS WAY
OWINGS MILLS MD
21117-5001
US

V. Phone/Fax

Practice location:
  • Phone: 443-796-8974
  • Fax:
Mailing address:
  • Phone: 443-796-8974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number10277147459
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: