Basic Information
Provider Information
NPI: 1003012063
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NWAOGWUGWU
FirstName: UZOAMAKA
MiddleName: THEODORA
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: NWIGWE
OtherFirstName: UZOAMAKA
OtherMiddleName: THEODORA
OtherNamePrefix: DR.
OtherNameSuffix:  
OtherCredential: MD
OtherLastNameType: 1
Mailing Information
Address1: 4700 RIDGELINE TER
Address2:  
City: BOWIE
State: MD
PostalCode: 207203706
CountryCode: US
TelephoneNumber: 3015764068
FaxNumber: 7328292266
Practice Location
Address1: 2041 GEORGIA AVENUE NW
Address2:  
City: WASHINGTON
State: DC
PostalCode: 200600001
CountryCode: US
TelephoneNumber: 2028657677
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/26/2007
LastUpdateDate: 10/05/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XD0068038MDN Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000XMD040316DCY Allopathic & Osteopathic PhysiciansInternal Medicine 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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