Healthcare Provider Details

I. General information

NPI: 1710320312
Provider Name (Legal Business Name): MARY ANN N. ONYEALI MD, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BLVD
BALTIMORE MD
21239-2945
US

IV. Provider business mailing address

8118 GOOD LUCK RD
LANHAM MD
20706-3574
US

V. Phone/Fax

Practice location:
  • Phone: 443-444-8000
  • Fax:
Mailing address:
  • Phone: 301-552-8118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD83953
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: