Provider Demographics
NPI:1194805036
Name:NKWANYUO, JOSEPH A (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:NKWANYUO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-1316
Mailing Address - Country:US
Mailing Address - Phone:410-265-7742
Mailing Address - Fax:410-298-3964
Practice Address - Street 1:8930 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4234
Practice Address - Country:US
Practice Address - Phone:410-265-7742
Practice Address - Fax:410-298-3964
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD30309207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD351941400Medicaid
MD351941400Medicaid
MDB69657Medicare UPIN