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
State | License ID | Taxonomies |
---|---|---|
MD | D0066706 | 207L00000X, 207LP2900X, 208VP0014X |
DC | MD039935 | 207LP2900X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208VP0014X | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | |
No | 207LP2900X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |