Provider Demographics
NPI:1780223628
Name:AHAGHOTU, LINDA CHIDINMA (NP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:CHIDINMA
Last Name:AHAGHOTU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 MARGIE CT
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1985
Mailing Address - Country:US
Mailing Address - Phone:240-535-9943
Mailing Address - Fax:
Practice Address - Street 1:4605 MARGIE CT
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-1985
Practice Address - Country:US
Practice Address - Phone:240-535-9943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-24
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR164222363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health