Basic Information
Provider Information
NPI: 1871869578
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MADU
FirstName: NNEKA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8118 GOOD LUCK RD
Address2:  
City: LANHAM
State: MD
PostalCode: 207063574
CountryCode: US
TelephoneNumber: 3015528118
FaxNumber:  
Practice Location
Address1: 8118 GOOD LUCK RD # MD
Address2:  
City: LANHAM
State: MD
PostalCode: 207063574
CountryCode: US
TelephoneNumber: 3015528118
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/27/2012
LastUpdateDate: 02/20/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/20/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XD0082696MDY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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