Provider Demographics
NPI:1699195081
Name:IGWE, IJEOMA
Entity Type:Individual
Prefix:
First Name:IJEOMA
Middle Name:
Last Name:IGWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HELEN CT
Mailing Address - Street 2:
Mailing Address - City:INDIAN HEAD
Mailing Address - State:MD
Mailing Address - Zip Code:20640-1967
Mailing Address - Country:US
Mailing Address - Phone:240-535-8731
Mailing Address - Fax:301-586-4767
Practice Address - Street 1:9 HELEN CT
Practice Address - Street 2:
Practice Address - City:INDIAN HEAD
Practice Address - State:MD
Practice Address - Zip Code:20640-1967
Practice Address - Country:US
Practice Address - Phone:240-535-8731
Practice Address - Fax:240-586-4767
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3467251E00000X
MDR3973251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD205507400Medicaid