1881765170 NPI number — DR. CHRISTIAN NNAMDI NWANKWO JR. M.D., MPH, FAAFP

Table of content: DR. CHRISTIAN NNAMDI NWANKWO JR. M.D., MPH, FAAFP (NPI 1881765170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881765170 NPI number — DR. CHRISTIAN NNAMDI NWANKWO JR. M.D., MPH, FAAFP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NWANKWO
Provider First Name:
CHRISTIAN
Provider Middle Name:
NNAMDI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D., MPH, FAAFP
Provider Gender Code:
M

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:
1881765170
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 FIRSTFIELD RD
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
GAITHERSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20878-1774
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-977-9077
Provider Business Mailing Address Fax Number:
301-977-0402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 FIRSTFIELD RD
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
GAITHERSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20878-1774
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-977-9077
Provider Business Practice Location Address Fax Number:
301-977-0402
Provider Enumeration Date:
11/10/2006

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: 207QS0010X , with the licence number:  D44239 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 146781601 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".