Provider Demographics
NPI:1386623205
Name:UWANAMODO, IHEANYI C (MD)
Entity type:Individual
Prefix:
First Name:IHEANYI
Middle Name:C
Last Name:UWANAMODO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20119 CIDER BARREL DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-2708
Mailing Address - Country:US
Mailing Address - Phone:301-523-0203
Mailing Address - Fax:301-515-7870
Practice Address - Street 1:15005 SHADY GROVE RD STE 200
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6358
Practice Address - Country:US
Practice Address - Phone:301-523-0203
Practice Address - Fax:301-515-7870
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055686207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG43360Medicare UPIN