Healthcare Provider Details

I. General information

NPI: 1669477253
Provider Name (Legal Business Name): NEIL R. OHORA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18111 PRINCE PHILLIP DR S-212
OLNEY MD
20832-1513
US

IV. Provider business mailing address

18111 PRINCE PHILLIP DR S-212
OLNEY MD
20832-1513
US

V. Phone/Fax

Practice location:
  • Phone: 301-774-1200
  • Fax: 301-774-5820
Mailing address:
  • Phone: 301-774-1200
  • Fax: 301-774-5820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0995
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: