Healthcare Provider Details

I. General information

NPI: 1649695701
Provider Name (Legal Business Name): CHINEME UMUNNA EZEIGWE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHINEME EZEIGWE PA

II. Dates (important events)

Enumeration Date: 02/26/2014
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8106 STAYTON DR STE D
JESSUP MD
20794-9615
US

IV. Provider business mailing address

8012 PATUXENT LANDING LOOP
LAUREL MD
20724-1975
US

V. Phone/Fax

Practice location:
  • Phone: 301-725-5050
  • Fax: 301-725-5111
Mailing address:
  • Phone: 240-882-7989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0003044
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: