Provider Demographics
NPI:1811411283
Name:IJOMA, SAMUEL ONYEBUCHI (PHD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ONYEBUCHI
Last Name:IJOMA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7654
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20907-7654
Mailing Address - Country:US
Mailing Address - Phone:410-948-8906
Mailing Address - Fax:
Practice Address - Street 1:6948 MAYFAIR TER
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5213
Practice Address - Country:US
Practice Address - Phone:410-948-8906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-27
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No253Z00000XAgenciesIn Home Supportive Care
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies