Provider Demographics
NPI:1215391677
Name:OSURUAKA, GLORIA A (MD)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:A
Last Name:OSURUAKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11921 ROCKVILLE PIKE STE 402
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2757
Mailing Address - Country:US
Mailing Address - Phone:571-248-7467
Mailing Address - Fax:
Practice Address - Street 1:11921 ROCKVILLE PIKE STE 402
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2757
Practice Address - Country:US
Practice Address - Phone:425-658-2254
Practice Address - Fax:301-888-8261
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2023-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0481642084P0800X
VA1012714242084P0800X
MDD894922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry