Provider Demographics
NPI:1437704103
Name:IKEJIOFOR, MOSES EKEMEZIE (PMHNP)
Entity Type:Individual
Prefix:MR
First Name:MOSES
Middle Name:EKEMEZIE
Last Name:IKEJIOFOR
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3711 STONEYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4134
Mailing Address - Country:US
Mailing Address - Phone:443-858-3581
Mailing Address - Fax:
Practice Address - Street 1:1501 SULGRAVE AVE STE 301
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3651
Practice Address - Country:US
Practice Address - Phone:443-869-2550
Practice Address - Fax:443-869-2750
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR1654932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry