Provider Demographics
NPI:1114938800
Name:ONYEAGHALA, NWAEHIHIE HARRISON (MD)
Entity Type:Individual
Prefix:
First Name:NWAEHIHIE
Middle Name:HARRISON
Last Name:ONYEAGHALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NWAEHIHIE
Other - Middle Name:H
Other - Last Name:ONYEAGHALA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:12150 ANNAPOLIS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9183
Mailing Address - Country:US
Mailing Address - Phone:301-464-7601
Mailing Address - Fax:866-885-9817
Practice Address - Street 1:12150 ANNAPOLIS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9183
Practice Address - Country:US
Practice Address - Phone:301-464-7601
Practice Address - Fax:866-885-9817
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01011221463207R00000X, 208D00000X
MDD0053461208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine