Provider Demographics
NPI:1497999775
Name:NDUBUIZU, ADANMA NGOZI (MD)
Entity Type:Individual
Prefix:
First Name:ADANMA
Middle Name:NGOZI
Last Name:NDUBUIZU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9710 PATUXENT WOODS DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1526
Mailing Address - Country:US
Mailing Address - Phone:301-575-8080
Mailing Address - Fax:
Practice Address - Street 1:9710 PATUXENT WOODS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1526
Practice Address - Country:US
Practice Address - Phone:301-575-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35022207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC350220Medicaid
SCSC55142353Medicare PIN