Provider Demographics
NPI:1801407028
Name:EBOH, NGOZI MARTHA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:NGOZI
Middle Name:MARTHA
Last Name:EBOH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 ORA GLEN DR UNIT 1224
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20768-7562
Mailing Address - Country:US
Mailing Address - Phone:301-351-5615
Mailing Address - Fax:
Practice Address - Street 1:110 IRVING ST NW # 2HICU
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3017
Practice Address - Country:US
Practice Address - Phone:202-877-7753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR170965363LF0000X
DCRN1007255282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily