Healthcare Provider Details

I. General information

NPI: 1417376989
Provider Name (Legal Business Name): UCHECHI ANOZIE IWEALA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7811 MONTROSE RD STE 340
POTOMAC MD
20854-3359
US

IV. Provider business mailing address

7811 MONTROSE RD STE 340
POTOMAC MD
20854-3359
US

V. Phone/Fax

Practice location:
  • Phone: 301-588-7888
  • Fax: 301-588-3419
Mailing address:
  • Phone: 301-588-7888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD89666
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberD89666
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: