Provider Demographics
NPI:1528380078
Name:MUO, IJEOMA MAUREEN (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:IJEOMA
Middle Name:MAUREEN
Last Name:MUO
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:IJEOMA
Other - Last Name:MUO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10 NORTH GREENE STREET, GRECC, BT/18/GR
Mailing Address - Street 2:BALTIMORE VAMC,
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:410-605-7000
Mailing Address - Fax:
Practice Address - Street 1:2332 BEVERLY HILLS DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76114-1756
Practice Address - Country:US
Practice Address - Phone:817-378-0855
Practice Address - Fax:817-378-0861
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256080-1207R00000X
VA0101247787207R00000X
TXS3254207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine