Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | R199931 | MD |
NPI | 1003168964 |
---|---|
Provider Name | Mr. Raymond Aseh Ofe |
First Address | Upper Marlboro, MD 20772-4680 |
Second Address | Largo, MD 20774-5340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2012 |
Last Update Date | 18/12/2019 |