1093205866 NPI number — MS. NGOZIKA CHINOENYE IFEOMA EGBUONU M.A., M.S.

Table of content: MS. NGOZIKA CHINOENYE IFEOMA EGBUONU M.A., M.S. (NPI 1093205866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093205866 NPI number — MS. NGOZIKA CHINOENYE IFEOMA EGBUONU M.A., M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EGBUONU
Provider First Name:
NGOZIKA CHINOENYE
Provider Middle Name:
IFEOMA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093205866
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13612 TREE LEAF CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPPER MARLBORO
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20774-4205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-501-8616
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1651 OLD MEADOW RD STE 600
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MC LEAN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22102-4389
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-564-1639
Provider Business Practice Location Address Fax Number:
703-734-1932
Provider Enumeration Date:
05/16/2018

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: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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