Provider Demographics
NPI:1104053362
Name:ONYEAGORO, SANDRA (MD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:ONYEAGORO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7628 ELMCREST RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1873
Mailing Address - Country:US
Mailing Address - Phone:301-326-7818
Mailing Address - Fax:410-799-1627
Practice Address - Street 1:4100 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-5506
Practice Address - Country:US
Practice Address - Phone:443-364-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-001202084P0800X
390200000X
MDD00823062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1104053362Medicaid