Healthcare Provider Details

I. General information

NPI: 1972408912
Provider Name (Legal Business Name): MR. MAXWELL OKWENSY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

9701 PHILADELPHIA CT # G4
LANHAM MD
20706-4400
US

IV. Provider business mailing address

11902 BRISTOLWOOD TER
LAUREL MD
20708-3183
US

V. Phone/Fax

Practice location:
  • Phone: 301-377-8962
  • Fax:
Mailing address:
  • Phone: 240-755-6027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: