Provider Demographics
NPI:1609014810
Name:ODO MEDICAL ASSOCIATES LIMITED
Entity Type:Organization
Organization Name:ODO MEDICAL ASSOCIATES LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:IHEANYI
Authorized Official - Middle Name:CHINEDU
Authorized Official - Last Name:UWANAMODO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-523-0203
Mailing Address - Street 1:PO BOX 37622
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3622
Mailing Address - Country:US
Mailing Address - Phone:781-407-7713
Mailing Address - Fax:781-407-0998
Practice Address - Street 1:18501 RELIANT DR
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-5419
Practice Address - Country:US
Practice Address - Phone:301-523-0203
Practice Address - Fax:301-990-9168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055686207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG01016Medicare PIN