Provider Demographics
NPI:1760480099
Name:NWADIKE, VALINDA R (MD)
Entity Type:Individual
Prefix:MS
First Name:VALINDA
Middle Name:R
Last Name:NWADIKE
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 1:22590 SHADY CT FL 3
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-5009
Mailing Address - Country:US
Mailing Address - Phone:301-475-0145
Mailing Address - Fax:
Practice Address - Street 1:23140 MOAKLEY ST
Practice Address - Street 2:#1
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2930
Practice Address - Country:US
Practice Address - Phone:301-373-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2016-12-29
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
MDD0057540207V00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD992601100Medicaid
MD992601100Medicaid
H95384Medicare UPIN