Healthcare Provider Details

I. General information

NPI: 1356920300
Provider Name (Legal Business Name): ANGELICA EHIOBA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12158 CENTRAL AVE
MITCHELLVILLE MD
20721-1932
US

IV. Provider business mailing address

12158 CENTRAL AVE
MITCHELLVILLE MD
20721-1932
US

V. Phone/Fax

Practice location:
  • Phone: 301-430-2700
  • Fax: 301-779-9001
Mailing address:
  • Phone: 301-430-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0101160
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: