Healthcare Provider Details

I. General information

NPI: 1275772436
Provider Name (Legal Business Name): ODO MEDICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350C CHRISTOPHER AVE
GAITHERSBURG MD
20879-3660
US

IV. Provider business mailing address

350C CHRISTOPHER AVE
GAITHERSBURG MD
20879-3660
US

V. Phone/Fax

Practice location:
  • Phone: 301-527-8783
  • Fax:
Mailing address:
  • Phone: 301-527-8783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD0055686
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberD0055686
License Number StateMD

VIII. Authorized Official

Name: IJEOMA UWANAMODO
Title or Position: PRACTICE MANAGER
Credential:
Phone: 301-527-8783