Basic Information
| Provider Information | |||||||||
| NPI: | 1609014810 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ODO MEDICAL ASSOCIATES LIMITED | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 37622 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212973622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814077713 | ||||||||
| FaxNumber: | 7814070998 | ||||||||
| Practice Location | |||||||||
| Address1: | 18501 RELIANT DR | ||||||||
| Address2: | |||||||||
| City: | GAITHERSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208795419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015230203 | ||||||||
| FaxNumber: | 3019909168 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2009 | ||||||||
| LastUpdateDate: | 06/11/2014 | ||||||||
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| AuthorizedOfficialLastName: | UWANAMODO | ||||||||
| AuthorizedOfficialFirstName: | IHEANYI | ||||||||
| AuthorizedOfficialMiddleName: | CHINEDU | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 3015230203 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | D0055686 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.