Healthcare Provider Details

I. General information

NPI: 1447510953
Provider Name (Legal Business Name): USIWOMA ESENIGHE ENE ABUGO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 YORK RD
TIMONIUM MD
21093-6220
US

IV. Provider business mailing address

1209 YORK RD
TIMONIUM MD
21093-6220
US

V. Phone/Fax

Practice location:
  • Phone: 410-821-9490
  • Fax:
Mailing address:
  • Phone: 410-821-9490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License NumberD0098646
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0098646
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25MA11783500
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License NumberD0098646
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number25MA11783500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: