Provider Demographics
NPI:1124837810
Name:IKOCHA, AKUNNA CHISOM
Entity type:Individual
Prefix:
First Name:AKUNNA
Middle Name:CHISOM
Last Name:IKOCHA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10504 LOUISVILLE LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-6048
Mailing Address - Country:US
Mailing Address - Phone:240-938-8623
Mailing Address - Fax:
Practice Address - Street 1:10504 LOUISVILLE LN
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-6048
Practice Address - Country:US
Practice Address - Phone:240-938-8623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR204630363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health