Healthcare Provider Details

I. General information

NPI: 1982060083
Provider Name (Legal Business Name): ALEXANDER UGWUNNA UKAOMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8825 WOODYARD RD
CLINTON MD
20735-2754
US

IV. Provider business mailing address

8825 WOODYARD RD
CLINTON MD
20735-2754
US

V. Phone/Fax

Practice location:
  • Phone: 240-746-1330
  • Fax:
Mailing address:
  • Phone: 240-746-1330
  • Fax: 240-746-1333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1018157
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR214942
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: