Healthcare Provider Details

I. General information

NPI: 1467641183
Provider Name (Legal Business Name): EDITH NEBUWA ANIEDOBE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EDITH NEBUWA ONYEMAECHI

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 OLD WASHINGTON RD STE 203A
WALDORF MD
20602-3243
US

IV. Provider business mailing address

1500 FOREST GLEN RD
SILVER SPRING MD
20910-1483
US

V. Phone/Fax

Practice location:
  • Phone: 301-638-9670
  • Fax:
Mailing address:
  • Phone: 240-441-2588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD66162
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberD006612
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: