Healthcare Provider Details

I. General information

NPI: 1659202737
Provider Name (Legal Business Name): NKWOR EMEKA PETERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11300 CRANFORD DR
UPPER MARLBORO MD
20772-2725
US

IV. Provider business mailing address

11300 CRANFORD DR
UPPER MARLBORO MD
20772-2725
US

V. Phone/Fax

Practice location:
  • Phone: 240-468-1520
  • Fax:
Mailing address:
  • Phone: 240-468-1520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: