MEDICARE: ATHLETICSMD

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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1689546830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATHLETICSMD

Provider Business Mailing Address
First Line	:	3450 FORT MEADE RD STE 110
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20724-2070
Country	:	US
Telephone Number	:	844-348-6348
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 FORT MEADE RD STE 110
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20724-2070
Country	:	US
Telephone Number	:	844-348-6348
Fax Number	:	410-995-9986

Authorized Official
Title or Position	:	OWNER
Name	:	IMAOBONG CHINEDOZI
Credential	:	MD
Telephone Number	:	844-348-6348

Provider Enumeration Date	:	09/18/2025
Last Update Date	:	09/18/2025

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Directions to “ATHLETICSMD ” Practice Location

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