Provider Demographics
NPI:1760484281
Name:IGWEBE, THEODORE E (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:E
Last Name:IGWEBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2401 RESEARCH BLVD
Mailing Address - Street 2:350
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3215
Mailing Address - Country:US
Mailing Address - Phone:240-731-4872
Mailing Address - Fax:301-972-2057
Practice Address - Street 1:6327 MORNING DEW CT
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1150
Practice Address - Country:US
Practice Address - Phone:240-731-4872
Practice Address - Fax:301-972-2057
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052927207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0J43OtherBCBSMD
110178865OtherRAILROAD MEDICARE
MD203803000Medicaid
DC4483OtherBCBSNCA
DC4483OtherBCBSNCA
MD203803000Medicaid