1780728154 NPI number — ADORA N OTIJI MD

Table of content: ADORA N OTIJI MD (NPI 1780728154)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780728154 NPI number — ADORA N OTIJI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OTIJI
Provider First Name:
ADORA
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NWOSU
Provider Other First Name:
ADORA
Provider Other Middle Name:
N
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780728154
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 WATKINS PARK DR
Provider Second Line Business Mailing Address:
FAMILY MEDICINE, LOWER LEVEL
Provider Business Mailing Address City Name:
UPPER MARLBORO
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20774-1628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-350-8500
Provider Business Mailing Address Fax Number:
301-350-8503

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 WATKINS PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPPER MARLBORO
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20774-1628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-350-8500
Provider Business Practice Location Address Fax Number:
301-350-8503
Provider Enumeration Date:
02/17/2007

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: 207Q00000X , with the licence number:  D0066811 , registered in the state of MD ; 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)

  • Identifier: 037830500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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