Provider Demographics
NPI:1699093658
Name:NGOZIKA NWANERI, MDPC
Entity type:Organization
Organization Name:NGOZIKA NWANERI, MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NGOZIKA
Authorized Official - Middle Name:J
Authorized Official - Last Name:NWANERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-459-6040
Mailing Address - Street 1:7214 KEMPTON RD
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1104
Mailing Address - Country:US
Mailing Address - Phone:301-459-6040
Mailing Address - Fax:301-731-6163
Practice Address - Street 1:7214 KEMPTON RD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-1104
Practice Address - Country:US
Practice Address - Phone:301-459-6040
Practice Address - Fax:301-731-6163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-14
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC9171174400000X
MDD23145174400000X
VA0101027840174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC019929600Medicaid
MD362761600Medicaid
DC019929600Medicaid
MD362761600Medicaid