MEDICARE: CLARA AHAGHOTU

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R135133	MD

General Provider Information

NPI Number	:	1932707197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARA AHAGHOTU

Provider Business Mailing Address
First Line	:	13207 ARRIBA GREENFIELDS DR
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-6332
Country	:	US
Telephone Number	:	301-675-7676
Fax Number	:

Provider Business Practice Location Address
First Line	:	13207 ARRIBA GREENFIELDS DR
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720
Country	:	US
Telephone Number	:	301-675-7676
Fax Number	:

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

Provider Enumeration Date	:	10/10/2020
Last Update Date	:	03/18/2026

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Directions to “ CLARA AHAGHOTU ” Practice Location

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