MEDICARE: IJOMAH AND ASSOCIATES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
2	101Y00000X	Counselor
3	103T00000X	Psychologist
4	104100000X	Social Worker
5	363L00000X	Nurse Practitioner
6	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1023514213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IJOMAH AND ASSOCIATES INC

Provider Business Mailing Address
First Line	:	4607 69TH AVE
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-2123
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4607 69TH AVE
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-2123
Country	:	US
Telephone Number	:	301-821-1671
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	BEN IJOMAH
Credential	:
Telephone Number	:	301-821-1671

Provider Enumeration Date	:	04/05/2018
Last Update Date	:	04/05/2018

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Directions to “IJOMAH AND ASSOCIATES INC ” Practice Location

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