Individual
ILEVBA UWAILA OSARENKHOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7503 SURRATTS RD, CLINTON, MD 20735-3358
(301) 868-8000
Mailing address
7503 SURRATTS RD, CLINTON, MD 20735-3358
(301) 868-8000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
255678
MA
208000000X
Pediatrics Physician
Primary
D0067100
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110097583A
—
MA
Enumeration date
04/10/2008
Last updated
10/27/2020
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