Healthcare Provider Details

I. General information

NPI: 1144377490
Provider Name (Legal Business Name): OKECHUKWU A NWODIM D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 OLD BRANCH AVE STE B201
CLINTON MD
20735-1628
US

IV. Provider business mailing address

8116 GOOD LUCK RD STE 305
LANHAM MD
20706-3502
US

V. Phone/Fax

Practice location:
  • Phone: 301-868-0150
  • Fax: 301-868-0243
Mailing address:
  • Phone: 301-868-0150
  • Fax: 301-868-0243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH0058158
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: