MEDICARE: DR. CHINENYE SYLVESTER EKOH M.D.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	D0059208	MD
2	2084P0800X	Psychiatry Physician	MD034571	DC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	64259002	OTHER	MD	SECURITY BCBS MEDICAREHMO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	7537763	OTHER		AETNA
3	K5360001	OTHER	DC	BCBS NATIONAL
4	1963	OTHER		COMPCARE
5	64259002	OTHER	MD	BLUECROSS BLUESHIELD
6	4171	OTHER		ELDERHEALTH

General Provider Information

NPI Number	:	1194718544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHINENYE SYLVESTER EKOH M.D.

Provider Business Mailing Address
First Line	:	13004 BALD HORNET TRCE
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-4681
Country	:	US
Telephone Number	:	202-320-9963
Fax Number	:	301-352-4334

Provider Business Practice Location Address
First Line	:	13004 BALD HORNET TRCE
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-4681
Country	:	US
Telephone Number	:	202-320-9963
Fax Number	:	301-352-4334

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	04/20/2008

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Directions to “ DR. CHINENYE SYLVESTER EKOH M.D.” Practice Location

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