Healthcare Provider Details

I. General information

NPI: 1497476923
Provider Name (Legal Business Name): CHINENYE PEACE OKORIE-UKAEGBU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 THAYER AVE
SILVER SPRING MD
20910-4508
US

IV. Provider business mailing address

723 UNDERWOOD ST NW
WASHINGTON DC
20012-2663
US

V. Phone/Fax

Practice location:
  • Phone: 301-755-6107
  • Fax:
Mailing address:
  • Phone: 301-549-8235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberP139619
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: