Individual
MRS. CHINYERE NGOZI EZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
11750 BUSINESS PARK DR, SUITE 103, WALDORF, MD 20601-2907
(240) 419-3865
Mailing address
11750 BUSINESS PARK DR, SUITE 103, WALDORF, MD 20601-2907
(240) 419-3865
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
0110003552
VA
363AM0700X
Medical Physician Assistant
5103548
FL
363AM0700X
Medical Physician Assistant
Primary
C0004111
MD
363AM0700X
Medical Physician Assistant
PA030649
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0110003552
STATE LICENSE
VA
01
—
5103548
STATE LICENSURE
FL
01
—
C0004111
STATE LICENSE
MD
01
—
CA1000041
CDS
DC
01
—
PA030649
STATE LICENSE
DC
Enumeration date
04/18/2007
Last updated
05/08/2012
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