Healthcare Provider Details

I. General information

NPI: 1275136475
Provider Name (Legal Business Name): IBE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 MEDICAL CENTER DR STE 105
LARGO MD
20774-3703
US

IV. Provider business mailing address

9500 MEDICAL CENTER DR STE 105
LARGO MD
20774-3703
US

V. Phone/Fax

Practice location:
  • Phone: 301-615-4133
  • Fax: 240-245-2918
Mailing address:
  • Phone: 301-615-4133
  • Fax: 240-245-2918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ULOMA IBE
Title or Position: OWNER
Credential: MD
Phone: 202-704-3010