Provider Demographics
NPI:1780652446
Name:EJIOFOH, STELLA D (MD)
Entity Type:Individual
Prefix:DR
First Name:STELLA
Middle Name:D
Last Name:EJIOFOH
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 1:9160 CARRIAGE HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-4076
Mailing Address - Country:US
Mailing Address - Phone:202-246-0756
Mailing Address - Fax:
Practice Address - Street 1:9160 CARRIAGE HOUSE LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-4076
Practice Address - Country:US
Practice Address - Phone:202-246-0756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD057665207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD686000100Medicaid
MD686000100Medicaid
MD858MJ755Medicare ID - Type Unspecified