Healthcare Provider Details

I. General information

NPI: 1407051899
Provider Name (Legal Business Name): GEORGINA OWUSU-ASIEDU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20010 CENTURY BLVD #200
GERMANTOWN MD
20874-1115
US

IV. Provider business mailing address

20010 CENTURY BLVD #200
GERMANTOWN MD
20874-1115
US

V. Phone/Fax

Practice location:
  • Phone: 240-686-2300
  • Fax:
Mailing address:
  • Phone: 240-686-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101247833
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: