Provider Demographics
NPI:1467131680
Name:O&D HEALTHCARE CENTER
Entity Type:Organization
Organization Name:O&D HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DELPHINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:IKPASAJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-882-5557
Mailing Address - Street 1:928 LONG MANOR DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-1700
Mailing Address - Country:US
Mailing Address - Phone:443-882-5557
Mailing Address - Fax:
Practice Address - Street 1:928 LONG MANOR DR
Practice Address - Street 2:
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-1700
Practice Address - Country:US
Practice Address - Phone:443-882-5557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty