Healthcare Provider Details

I. General information

NPI: 1659716256
Provider Name (Legal Business Name): CYNTHIA CHIKA ODOGWU M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 MERCANTILE LN
LARGO MD
20774-5374
US

IV. Provider business mailing address

2101 E JEFFERSON ST STE 6W
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 301-618-5500
  • Fax:
Mailing address:
  • Phone: 301-816-5853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberD82165
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number042.0017890-COMP
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: