Healthcare Provider Details

I. General information

NPI: 1114938800
Provider Name (Legal Business Name): NWAEHIHIE HARRISON ONYEAGHALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NWAEHIHIE H ONYEAGHALA MD

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12150 ANNAPOLIS RD STE 100
GLENN DALE MD
20769-9183
US

IV. Provider business mailing address

PO BOX 7321
LARGO MD
20792-7321
US

V. Phone/Fax

Practice location:
  • Phone: 301-464-7601
  • Fax: 866-885-9817
Mailing address:
  • Phone: 301-464-7601
  • Fax: 866-885-9817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberD0053461
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01011221463
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number01011221463
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: