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General NPI Number Information
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NPI Number | 1053809186
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Entity Type | Individual
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Provider Name | DR. EJIOFOR ANTHONY DARRELL EZEKWE JR.
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Gender | Male
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Dates
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Enumeration Date | 04/24/2018
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 10 CENTER DR
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City | BETHESDA
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State | MD
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Zip | 20892-4220
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Country | US
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Telephone | 240-539-8378
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Fax |
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Provider Business Mailing Address
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Address Line | 8348 SILVER TRUMPET DR
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City | COLUMBIA
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State | MD
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Zip | 21045-5635
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Country | US
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Telephone | 410-790-4884
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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 | 2080P0201X
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Taxonomy Name | Pediatric Allergy/Immunology Physician
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License Number | D0102616
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2080P0201X
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Taxonomy Name | Pediatric Allergy/Immunology Physician
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License Number | MD049272
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License Number State | DC
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