Provider Demographics
NPI:1578876264
Name:BELITEHORIZONMEDICALCENTER
Entity Type:Organization
Organization Name:BELITEHORIZONMEDICALCENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIDEHA
Authorized Official - Middle Name:MACDONALD
Authorized Official - Last Name:OHUOHA
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:301-630-4009
Mailing Address - Street 1:3704 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-3010
Mailing Address - Country:US
Mailing Address - Phone:301-630-4009
Mailing Address - Fax:301-630-6916
Practice Address - Street 1:26825 POINTLOOK OUT ROAD
Practice Address - Street 2:STEE
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650
Practice Address - Country:US
Practice Address - Phone:301-997-0125
Practice Address - Fax:301-997-0126
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BELITEHORIZONMEDICALCENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-22
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDBC41782632084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD160331100Medicaid
MD160331101Medicaid