Provider Demographics
NPI:1265491070
Name:AZINGE, NICHOLAS NWABUSI (MD,FACP)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:NWABUSI
Last Name:AZINGE
Suffix:
Gender:M
Credentials:MD,FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1041
Mailing Address - Street 2:M-17
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20741-1041
Mailing Address - Country:US
Mailing Address - Phone:301-220-3500
Mailing Address - Fax:301-982-0321
Practice Address - Street 1:2041 GEORGIA AVE NW STE 5100
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-2354
Practice Address - Country:US
Practice Address - Phone:202-865-6625
Practice Address - Fax:202-865-3833
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD31363207R00000X
MDD00053210207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC027438200Medicaid
MD166001200Medicaid
DCG01679G01Medicare PIN
MDG01679G01Medicare PIN