Provider Demographics
NPI:1194718544
Name:EKOH, CHINENYE SYLVESTER (MD)
Entity type:Individual
Prefix:DR
First Name:CHINENYE
Middle Name:SYLVESTER
Last Name:EKOH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13004 BALD HORNET TRCE
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4681
Mailing Address - Country:US
Mailing Address - Phone:202-320-9963
Mailing Address - Fax:301-352-4334
Practice Address - Street 1:13004 BALD HORNET TRCE
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-4681
Practice Address - Country:US
Practice Address - Phone:202-320-9963
Practice Address - Fax:301-352-4334
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00592082084P0800X
DCMD0345712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD64259002OtherSECURITY BCBS MEDICAREHMO
7537763OtherAETNA
DCK5360001OtherBCBS NATIONAL
1963OtherCOMPCARE
MD64259002OtherBLUECROSS BLUESHIELD
4171OtherELDERHEALTH
1963OtherCOMPCARE
DC492004Medicare PIN
P00312143Medicare PIN
$$$$$$$$$OtherTRICARE
MD445SMedicare PIN