1528380078 NPI number — DR. IJEOMA MAUREEN MUO MD, MPH

Table of content: DR. IJEOMA MAUREEN MUO MD, MPH (NPI 1528380078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528380078 NPI number — DR. IJEOMA MAUREEN MUO MD, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUO
Provider First Name:
IJEOMA
Provider Middle Name:
MAUREEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, MPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MUO
Provider Other First Name:
MAUREEN
Provider Other Middle Name:
IJEOMA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1528380078
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 NORTH GREENE STREET, GRECC, BT/18/GR
Provider Second Line Business Mailing Address:
BALTIMORE VAMC,
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-605-7000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2332 BEVERLY HILLS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76114-1756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-378-0855
Provider Business Practice Location Address Fax Number:
817-378-0861
Provider Enumeration Date:
02/25/2010

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: 207R00000X , with the licence number:  256080-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 0101247787 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: S3254 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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