Provider Demographics
NPI:1164596862
Name:CECILIA A NWANKWO M D F A A P P C
Entity Type:Organization
Organization Name:CECILIA A NWANKWO M D F A A P P C
Other - Org Name:CAPITAL PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:ADAOBI
Authorized Official - Last Name:NWANKWO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-330-4243
Mailing Address - Street 1:17 FIRSTFIELD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1774
Mailing Address - Country:US
Mailing Address - Phone:301-330-4243
Mailing Address - Fax:301-963-9114
Practice Address - Street 1:17 FIRSTFIELD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1774
Practice Address - Country:US
Practice Address - Phone:301-330-4243
Practice Address - Fax:301-963-9114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0037545208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD334511400Medicaid
MD0N05CAOtherBLUE CROSS OF MD
MDA362OtherCAREFIRST PROVIDER NUMBER
MD334511400Medicaid