Provider Demographics
NPI:1982060083
Name:UKAOMA, ALEXANDER UGWUNNA
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:UGWUNNA
Last Name:UKAOMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 NANNIE HELEN BURROUGHS AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-5506
Mailing Address - Country:US
Mailing Address - Phone:301-408-4111
Mailing Address - Fax:
Practice Address - Street 1:7517 NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6969
Practice Address - Country:US
Practice Address - Phone:301-408-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1018157363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily