Healthcare Provider Details

I. General information

NPI: 1316366388
Provider Name (Legal Business Name): IFEOMA OKADIGBO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9662 PENNSYLVANIA AVE
UPPER MARLBORO MD
20772
US

IV. Provider business mailing address

9662 PENNYSYLVANIA AVENUE
UPPER MARLBORO MD
20772
US

V. Phone/Fax

Practice location:
  • Phone: 301-599-1500
  • Fax:
Mailing address:
  • Phone: 301-599-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberD0087359
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD047347
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: