Healthcare Provider Details

I. General information

NPI: 1710678776
Provider Name (Legal Business Name): ADAORA OGBUACHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6005 LANDOVER RD STE 1
CHEVERLY MD
20785-1145
US

IV. Provider business mailing address

6505 OAK FOREST CT
CHEVERLY MD
20785-3167
US

V. Phone/Fax

Practice location:
  • Phone: 301-437-4344
  • Fax: 301-322-4886
Mailing address:
  • Phone: 301-437-4344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR157570
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: