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General NPI Number Information
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NPI Number | 1205014263
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Entity Type | Organization
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Legal Business Name | AGNES HEALTH QUICK CARE CLINIC
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Dates
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Enumeration Date | 02/01/2008
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Last Update Date | 02/01/2008
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Provider Practice Location Address
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Address Line | 219 W BEL AIR AVE SUITE 2
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City | ABERDEEN
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State | MD
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Zip | 21001-3256
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Country | US
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Telephone | 410-272-7474
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Fax | 410-272-7442
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Provider Business Mailing Address
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Address Line | 219 W BEL AIR AVE SUITE 2
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City | ABERDEEN
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State | MD
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Zip | 21001-3256
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Country | US
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Telephone | 410-272-7474
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Fax | 410-272-7442
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Authorized Official
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Title or Position | CLINIC PHYSICIAN PRESIDENT
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Name | DR. OKECHUKWU A NWODIN
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Credential | DO
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Telephone | 410-272-7474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | H0058158
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License Number State | MD
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