Provider Demographics
NPI:1609861459
Name:NWANDU, ANTHEA EDU (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHEA
Middle Name:EDU
Last Name:NWANDU
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:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-706-4613
Mailing Address - Fax:410-328-1112
Practice Address - Street 1:725 W LOMBARD ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1009
Practice Address - Country:US
Practice Address - Phone:410-558-4888
Practice Address - Fax:410-327-1693
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0044598207R00000X
MDD44598207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD050841100Medicaid
MD050841100Medicaid
MD226780Y2ZMedicare PIN