Provider Demographics
NPI:1710262043
Name:A&O HEALTHCARE
Entity Type:Organization
Organization Name:A&O HEALTHCARE
Other - Org Name:OMNI PRIMARY & URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADORA
Authorized Official - Middle Name:
Authorized Official - Last Name:OTIJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-351-5374
Mailing Address - Street 1:20 WATKINS PARK DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1628
Mailing Address - Country:US
Mailing Address - Phone:240-351-5374
Mailing Address - Fax:240-280-0216
Practice Address - Street 1:20 WATKINS PARK DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1628
Practice Address - Country:US
Practice Address - Phone:240-351-5374
Practice Address - Fax:240-280-0216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0066811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty