MEDICARE: MR. JOHN IHUEZE IHEOMA

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	101YM0800X	Mental Health Counselor	211111835	MD

General Provider Information

NPI Number	:	1245976398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN IHUEZE IHEOMA

Provider Business Mailing Address
First Line	:	8700 CENTRAL AVE STE 300
Second Line	:
City	:	LANDOVER
State	:	MD
Zip	:	20785-4853
Country	:	US
Telephone Number	:	144-385-7919
Fax Number	:	240-619-4916

Provider Business Practice Location Address
First Line	:	8700 CENTRAL AVE STE 300
Second Line	:
City	:	LANDOVER
State	:	MD
Zip	:	20785-4853
Country	:	US
Telephone Number	:	443-857-9193
Fax Number	:	240-619-4916

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

Provider Enumeration Date	:	05/11/2022
Last Update Date	:	10/05/2023

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