Individual
OKECHUKWU ANTHONY IBEANU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9135 PISCATAWAY RD STE 420, CLINTON, MD 20735-2555
(301) 828-2555
Mailing address
9135 PISCATAWAY RD STE 420, CLINTON, MD 20735-2555
(301) 828-2555
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
15442R
LA
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
Primary
MD423582
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103065271
—
PA
05
—
1074497
—
LA
Enumeration date
07/25/2006
Last updated
03/02/2016
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