Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 15442R | LA |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | MD423582 | PA |
NPI | 1538182571 |
---|---|
Provider Name | Okechukwu Anthony Ibeanu |
First Address | Clinton, MD 20735-2555 |
Second Address | Clinton, MD 20735-2555 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 02/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103065271 | (05) | PA |
1074497 | (05) | LA |
I16886 | (02) |