MEDICARE: UGO JOHNSON AGWU

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	1041C0700X	Clinical Social Worker	LC500181850	DC

General Provider Information

NPI Number	:	1548734312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	UGO JOHNSON AGWU

Provider Business Mailing Address
First Line	:	6571 HIL MAR DR APT 301
Second Line	:
City	:	DISTRICT HTS
State	:	MD
Zip	:	20747-4136
Country	:	US
Telephone Number	:	202-422-9792
Fax Number	:

Provider Business Practice Location Address
First Line	:	6571 HIL MAR DR APT 301
Second Line	:
City	:	DISTRICT HTS
State	:	MD
Zip	:	20747-4136
Country	:	US
Telephone Number	:	202-422-9792
Fax Number	:

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

Provider Enumeration Date	:	01/15/2019
Last Update Date	:	01/15/2019

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