Provider Demographics
NPI:1205014263
Name:AGNES HEALTH QUICK CARE CLINIC
Entity Type:Organization
Organization Name:AGNES HEALTH QUICK CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC PHYSICIAN PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OKECHUKWU
Authorized Official - Middle Name:A
Authorized Official - Last Name:NWODIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:410-272-7474
Mailing Address - Street 1:219 W BEL AIR AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-3256
Mailing Address - Country:US
Mailing Address - Phone:410-272-7474
Mailing Address - Fax:410-272-7442
Practice Address - Street 1:219 W BEL AIR AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-3256
Practice Address - Country:US
Practice Address - Phone:410-272-7474
Practice Address - Fax:410-272-7442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0058158207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH54722Medicare UPIN