Provider Demographics
NPI:1275772436
Name:ODO MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:ODO MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IJEOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:UWANAMODO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-527-8783
Mailing Address - Street 1:350C CHRISTOPHER AVE
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3660
Mailing Address - Country:US
Mailing Address - Phone:301-527-8783
Mailing Address - Fax:
Practice Address - Street 1:350C CHRISTOPHER AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3660
Practice Address - Country:US
Practice Address - Phone:301-527-8783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055686207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty