Provider Demographics
NPI:1386673507
Name:IHEDIOHA, NAOMI (MD)
Entity type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:
Last Name:IHEDIOHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:NNEOMA
Other - Middle Name:
Other - Last Name:NWACHUKWU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1046 WEST ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-3531
Mailing Address - Country:US
Mailing Address - Phone:301-490-8383
Mailing Address - Fax:301-490-9770
Practice Address - Street 1:1046 WEST ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3531
Practice Address - Country:US
Practice Address - Phone:301-490-8383
Practice Address - Fax:301-490-9770
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD47838207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD212300200Medicaid
MDF89640Medicare UPIN
MD212300200Medicaid