Basic Information
| Provider Information | |||||||||
| NPI: | 1528380078 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUO | ||||||||
| FirstName: | IJEOMA | ||||||||
| MiddleName: | MAUREEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD, MPH | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MUO | ||||||||
| OtherFirstName: | MAUREEN | ||||||||
| OtherMiddleName: | IJEOMA | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10 NORTH GREENE STREET, GRECC, BT/18/GR | ||||||||
| Address2: | BALTIMORE VAMC, | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106057000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2332 BEVERLY HILLS DR | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761141756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173780855 | ||||||||
| FaxNumber: | 8173780861 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2010 | ||||||||
| LastUpdateDate: | 09/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 256080-1 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 0101247787 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | S3254 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.