Provider Demographics
NPI:1255387288
Name:NWADIUKO, RAYMOND O (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:O
Last Name:NWADIUKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAYMOND
Other - Middle Name:OKECHUKWU
Other - Last Name:NWADIUKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9831 GREENBELT RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2202
Mailing Address - Country:US
Mailing Address - Phone:301-552-4100
Mailing Address - Fax:301-552-1700
Practice Address - Street 1:9831 GREENBELT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2202
Practice Address - Country:US
Practice Address - Phone:301-552-4100
Practice Address - Fax:301-552-1700
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM34279207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD522090806OtherTAX ID
DC436140Medicare PIN
MDF46263Medicare UPIN