Healthcare Provider Details

I. General information

NPI: 1922262997
Provider Name (Legal Business Name): DR. UCHENWA DIANA OKOLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15000 BROSCHART RD
ROCKVILLE MD
20850-3303
US

IV. Provider business mailing address

15000 BROSCHART RD
ROCKVILLE MD
20850-3303
US

V. Phone/Fax

Practice location:
  • Phone: 301-251-6800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD046390
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberD84215
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD046390
License Number StateDC
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD84215
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: