Provider Demographics
NPI:1235134370
Name:NYANJOM, DAVID OGOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:OGOLA
Last Name:NYANJOM
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 1:10710 CHARTER DRIVE
Mailing Address - Street 2:STE 310
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3260
Mailing Address - Country:US
Mailing Address - Phone:410-997-5944
Mailing Address - Fax:410-997-1720
Practice Address - Street 1:10710 CHARTER DRIVE
Practice Address - Street 2:STE 310
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3260
Practice Address - Country:US
Practice Address - Phone:410-997-5944
Practice Address - Fax:410-997-1720
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0036974207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine