=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053365221
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ULNACS MEDICAL CARE, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2006
-----------------------------------------------------
Last Update Date | 07/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3331 TOLEDO TER STE 108
-----------------------------------------------------
City | HYATTSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20782-8156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-408-4111
-----------------------------------------------------
Fax | 301-408-4600
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3331 TOLEDO TER STE 108
-----------------------------------------------------
City | HYATTSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20782-8156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-408-4111
-----------------------------------------------------
Fax | 301-408-4600
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. GODSWILL O OKOJI
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 301-408-4111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | D0050545
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------