Healthcare Provider Details

I. General information

NPI: 1518318864
Provider Name (Legal Business Name): OMOJO ODIHI MALU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 ARMY PENTAGON
WASHINGTON DC
20310-5801
US

IV. Provider business mailing address

5801 ARMY PENTAGON
APO AA
20310
US

V. Phone/Fax

Practice location:
  • Phone: 703-692-8810
  • Fax: 703-693-4781
Mailing address:
  • Phone: 703-692-8810
  • Fax: 703-693-4781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0116029819
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: