Provider Demographics
NPI:1003952979
Name:NWANERI, ENYINNAYA ROSE (MD,MPH)
Entity Type:Individual
Prefix:DR
First Name:ENYINNAYA
Middle Name:ROSE
Last Name:NWANERI
Suffix:
Gender:F
Credentials:MD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:301-395-2074
Mailing Address - Fax:
Practice Address - Street 1:1221 MERCANTILE LN
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-5374
Practice Address - Country:US
Practice Address - Phone:301-395-2074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA38480207L00000X
MDT4863207LC0200X
MDD70572207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT4863OtherJHH DOCTOR'S NUMBER
MD10923222Medicare PIN
MDP00789812Medicare PIN
IAP00789812Medicare PIN
MDT4863OtherJHH DOCTOR'S NUMBER