Healthcare Provider Details

I. General information

NPI: 1063132140
Provider Name (Legal Business Name): SEVOX MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13219 EXECUTIVE PARK TER
GERMANTOWN MD
20874-2647
US

IV. Provider business mailing address

13219 EXECUTIVE PARK TER
GERMANTOWN MD
20874-2647
US

V. Phone/Fax

Practice location:
  • Phone: 443-548-0484
  • Fax: 240-744-5661
Mailing address:
  • Phone: 240-762-4141
  • Fax: 240-744-5661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL OSAGEDE IMOMOH
Title or Position: CRNA
Credential: DNAP
Phone: 240-898-5075