1497283097 NPI number — DR. CHIDINMA EZE PMHNP-BC, FNP-C

Table of content: DR. CHIDINMA EZE PMHNP-BC, FNP-C (NPI 1497283097)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497283097 NPI number — DR. CHIDINMA EZE PMHNP-BC, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EZE
Provider First Name:
CHIDINMA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PMHNP-BC, FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EZE
Provider Other First Name:
CHIDINMA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP-C, PMHNP-BC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1497283097
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9912 FARM POND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20708-6000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-254-6807
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 TAYLOR ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20011-5617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-464-9200
Provider Business Practice Location Address Fax Number:
202-291-2160
Provider Enumeration Date:
05/25/2017

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: 363LF0000X , with the licence number:  R185830 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: RN1015900 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: R185830 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: RN1015900 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 628655 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".