Healthcare Provider Details

I. General information

NPI: 1164596862
Provider Name (Legal Business Name): CECILIA A NWANKWO M D F A A P P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 FIRSTFIELD RD SUITE 200
GAITHERSBURG MD
20878-1774
US

IV. Provider business mailing address

17 FIRSTFIELD RD SUITE 200
GAITHERSBURG MD
20878-1774
US

V. Phone/Fax

Practice location:
  • Phone: 301-330-4243
  • Fax: 301-963-9114
Mailing address:
  • Phone: 301-330-4243
  • Fax: 301-963-9114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0037545
License Number StateMD

VIII. Authorized Official

Name: CECILIA ADAOBI NWANKWO
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 301-330-4243