Healthcare Provider Details

I. General information

NPI: 1386673507
Provider Name (Legal Business Name): NAOMI IHEDIOHA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. NNEOMA NWACHUKWU

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 07/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1046 WEST ST
LAUREL MD
20707-3531
US

IV. Provider business mailing address

1046 WEST ST
LAUREL MD
20707-3531
US

V. Phone/Fax

Practice location:
  • Phone: 301-490-8383
  • Fax: 301-490-9770
Mailing address:
  • Phone: 301-490-8383
  • Fax: 301-490-9770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD47838
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: