Healthcare Provider Details

I. General information

NPI: 1619289386
Provider Name (Legal Business Name): OBIANUJU GERALDINE NWOGA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2010
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date: 05/23/2023
Reactivation Date: 06/09/2023

III. Provider practice location address

11161 NEW HAMPSHIRE AVE STE 301
SILVER SPRING MD
20904-2606
US

IV. Provider business mailing address

903 RUSSELL AVE STE 301
GAITHERSBURG MD
20879-3257
US

V. Phone/Fax

Practice location:
  • Phone: 301-681-7101
  • Fax:
Mailing address:
  • Phone: 301-869-2292
  • Fax: 301-869-4223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0082106
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: