Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | D0044795 | MD |
NPI | 1033102348 |
---|---|
Provider Name | Dr. Ngozi Ruth Agwuna |
First Address | Ellicott City, MD 21042-7711 |
Second Address | Ellicott City, MD 21042-7711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2005 |
Last Update Date | 10/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
128051100 | (05) | MD |
522027939 | FEIN (01) | MD |
F75738 | (02) | MD |