Provider Demographics
NPI:1497084131
Name:NWOGU, ELERA YEYE (PA)
Entity Type:Individual
Prefix:MRS
First Name:ELERA
Middle Name:YEYE
Last Name:NWOGU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 NICOL CIR
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2955
Mailing Address - Country:US
Mailing Address - Phone:301-925-4554
Mailing Address - Fax:
Practice Address - Street 1:7940 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:GLENARDEN
Practice Address - State:MD
Practice Address - Zip Code:20706-1772
Practice Address - Country:US
Practice Address - Phone:301-341-5450
Practice Address - Fax:301-341-2424
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002905363AM0700X
DCPA030294363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical