Healthcare Provider Details

I. General information

NPI: 1992236236
Provider Name (Legal Business Name): OSAGIE UWADIA IGHILE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 04/13/2025
Certification Date: 04/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9384 FORESTWOOD LN STE A
MANASSAS VA
20110-4748
US

IV. Provider business mailing address

9384 FORESTWOOD LN STE A
MANASSAS VA
20110-4748
US

V. Phone/Fax

Practice location:
  • Phone: 703-369-2999
  • Fax: 703-369-3118
Mailing address:
  • Phone: 703-369-2999
  • Fax: 703-369-3118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101282571
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: