Healthcare Provider Details

I. General information

NPI: 1043594427
Provider Name (Legal Business Name): CHITUA ADA OKOH PHD, RD, LDN, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12219 CASTLEWALL CT
BOWIE MD
20720-3493
US

IV. Provider business mailing address

12219 CASTLEWALL CT
BOWIE MD
20720-3493
US

V. Phone/Fax

Practice location:
  • Phone: 301-352-7679
  • Fax:
Mailing address:
  • Phone: 301-352-7679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberN00035
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberD1710
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberN00035
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD1710
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: