Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | R215860 | MD |
NPI | 1053078253 |
---|---|
Provider Name | Okechukwu Matthew Ofodile |
First Address | Largo, MD 20774-5477 |
Second Address | Largo, MD 20774-5477 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2021 |
Last Update Date | 22/11/2021 |