Provider Demographics
NPI:1174184766
Name:NWABUEZE, AUGUSTINE B (MD)
Entity Type:Individual
Prefix:
First Name:AUGUSTINE
Middle Name:B
Last Name:NWABUEZE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5454 HARPERS FARM RD APT B3
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-1396
Mailing Address - Country:US
Mailing Address - Phone:240-713-0170
Mailing Address - Fax:
Practice Address - Street 1:5454 HARPERS FARM RD APT B3
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-1396
Practice Address - Country:US
Practice Address - Phone:240-713-0170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDHCS800178171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor