Healthcare Provider Details

I. General information

NPI: 1588531222
Provider Name (Legal Business Name): CHIDIEBERE JERRY UZOHO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 CHERRY LANE CT STE 108
LAUREL MD
20707-4978
US

IV. Provider business mailing address

14300 CHERRY LANE CT STE 108
LAUREL MD
20707-4978
US

V. Phone/Fax

Practice location:
  • Phone: 800-532-4513
  • Fax:
Mailing address:
  • Phone: 800-532-4513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberR229034
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: