Provider Demographics
NPI:1851348742
Name:WRIGHT, MOFIKPARA AUREOLUS (MD)
Entity Type:Individual
Prefix:DR
First Name:MOFIKPARA
Middle Name:AUREOLUS
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12617 SHOAL CREEK TER
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-1080
Mailing Address - Country:US
Mailing Address - Phone:202-236-2309
Mailing Address - Fax:301-576-3826
Practice Address - Street 1:6201 GREENBELT RD
Practice Address - Street 2:
Practice Address - City:BERWYN HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20740-2354
Practice Address - Country:US
Practice Address - Phone:301-486-4587
Practice Address - Fax:301-486-4558
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0050821207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD090812600Medicaid
MD663861Medicare ID - Type Unspecified
MD090812600Medicaid