Provider Demographics
NPI:1215481841
Name:IJOMOH, ISHIOMA
Entity type:Individual
Prefix:
First Name:ISHIOMA
Middle Name:
Last Name:IJOMOH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7729 RIVERDALE RD
Mailing Address - Street 2:APT 304
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3951
Mailing Address - Country:US
Mailing Address - Phone:240-615-7277
Mailing Address - Fax:
Practice Address - Street 1:7729 RIVERDALE RD
Practice Address - Street 2:APT 304
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3951
Practice Address - Country:US
Practice Address - Phone:240-615-7277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11805374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide