Organization
FAIRWOOD INTERNAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OKEOWO DARCY IBITOYE M.D. (MEDICAL DIRECTOR)
(240) 245-4414
Entity
Organization
Contact information
Practice address
12200 ANNAPOLIS RD, SUITE 232, GLENN DALE, MD 20769-9180
(240) 245-4414
(240) 245-4409
Mailing address
12200 ANNAPOLIS RD, SUITE 232, GLENN DALE, MD 20769-9180
(240) 245-4414
(240) 245-4409
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D0051437
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
723540200
—
MD
01
—
DX1GOD
CAREFIRST MARYLAND
MD
01
—
P366
CAREFIRST FEP
MD
Enumeration date
03/13/2009
Last updated
07/21/2009
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