Healthcare Provider Details

I. General information

NPI: 1548664576
Provider Name (Legal Business Name): IKECHUKWU STANLEY OJIEGBE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 RAINBOW CT
EDGEWOOD MD
21040-2333
US

IV. Provider business mailing address

703 RAINBOW CT
EDGEWOOD MD
21040-2333
US

V. Phone/Fax

Practice location:
  • Phone: 240-274-8822
  • Fax:
Mailing address:
  • Phone: 240-274-8822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP42234
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: