Healthcare Provider Details

I. General information

NPI: 1386623205
Provider Name (Legal Business Name): IHEANYI C UWANAMODO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15005 SHADY GROVE RD STE 200
ROCKVILLE MD
20850-6358
US

IV. Provider business mailing address

20119 CIDER BARREL DR
GERMANTOWN MD
20876-2708
US

V. Phone/Fax

Practice location:
  • Phone: 301-523-0203
  • Fax: 301-515-7870
Mailing address:
  • Phone: 301-523-0203
  • Fax: 301-515-7870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD0055686
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: