1750524898 NPI number — DR. EVA UMOH ASOMUGHA M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750524898 NPI number — DR. EVA UMOH ASOMUGHA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ASOMUGHA
Provider First Name:
EVA
Provider Middle Name:
UMOH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
UMOH
Provider Other First Name:
EVA
Provider Other Middle Name:
MACAULAY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750524898
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 75868
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21275-5868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-383-6469
Provider Business Mailing Address Fax Number:
703-810-5369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6355 WALKER LANE
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22310-3257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-810-5210
Provider Business Practice Location Address Fax Number:
703-810-5418
Provider Enumeration Date:
04/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  0101260371 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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