Provider Demographics
NPI:1356428833
Name:OSUALA, THEODORE C (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:C
Last Name:OSUALA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9470 ANNAPOLIS RD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3025
Mailing Address - Country:US
Mailing Address - Phone:301-577-9111
Mailing Address - Fax:301-577-9199
Practice Address - Street 1:9470 ANNAPOLIS RD
Practice Address - Street 2:SUITE 117
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3025
Practice Address - Country:US
Practice Address - Phone:301-577-9111
Practice Address - Fax:301-577-9199
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2022-08-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD00641262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD015197100Medicaid
00Y933Medicare PIN