Provider Demographics
NPI:1114373008
Name:EKEAGWU, VITALIS
Entity Type:Individual
Prefix:
First Name:VITALIS
Middle Name:
Last Name:EKEAGWU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 DODGE PARK RD APT 302
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2108
Mailing Address - Country:US
Mailing Address - Phone:301-323-5870
Mailing Address - Fax:
Practice Address - Street 1:3305 DODGE PARK RD APT 302
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-2108
Practice Address - Country:US
Practice Address - Phone:301-323-5870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide