Provider Demographics
NPI:1669524898
Name:BEWAYO, GEORGIA E (NP)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:E
Last Name:BEWAYO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4639 DIAMOND RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3103
Mailing Address - Country:US
Mailing Address - Phone:301-396-5753
Mailing Address - Fax:
Practice Address - Street 1:6 GARRETT AVENUE
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-4010
Practice Address - Country:US
Practice Address - Phone:301-539-5100
Practice Address - Fax:301-934-2084
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCF1106110363LF0000X
MDR179194363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD330813800Medicaid
DC003283M72Medicare UPIN