Provider Demographics
NPI:1174664007
Name:OPPONG, JOSEPH MAXWELL JR (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MAXWELL
Last Name:OPPONG
Suffix:JR
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 1:6911 LAUREL BOWIE RD
Mailing Address - Street 2:STE 212
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1712
Mailing Address - Country:US
Mailing Address - Phone:301-755-9500
Mailing Address - Fax:301-747-6017
Practice Address - Street 1:6911 LAUREL BOWIE RD
Practice Address - Street 2:STE 212
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1712
Practice Address - Country:US
Practice Address - Phone:301-755-9500
Practice Address - Fax:301-747-6017
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0066706207L00000X, 207LP2900X, 208VP0014X
DCMD039935207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine