Healthcare Provider Details

I. General information

NPI: 1164051363
Provider Name (Legal Business Name): AMY NWAOBASI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 MARTIN LUTHER KING JR AVE SE FL 3
WASHINGTON DC
20020-7024
US

IV. Provider business mailing address

2041 MARTIN LUTHER KING JR AVE SE FL 3
WASHINGTON DC
20020-7024
US

V. Phone/Fax

Practice location:
  • Phone: 202-889-3777
  • Fax: 202-315-0369
Mailing address:
  • Phone: 202-889-7900
  • Fax: 202-315-0369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD210012168
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: