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General NPI Number Information
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NPI Number | 1003032855
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Entity Type | Individual
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Provider Name | CHINYERE NGOZI EZE PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 05/08/2012
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Provider Practice Location Address
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Address Line | 11750 BUSINESS PARK DR SUITE 103
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City | WALDORF
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State | MD
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Zip | 20601-2907
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Country | US
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Telephone | 240-419-3865
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Fax |
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Provider Business Mailing Address
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Address Line | 11750 BUSINESS PARK DR SUITE 103
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City | WALDORF
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State | MD
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Zip | 20601-2907
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Country | US
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Telephone | 240-419-3865
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | C0004111
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA030649
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0110003552
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5103548
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License Number State | FL
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