| |
3331 Toledo Ter Ste 108 Hyattsville MD 20782-8156 | |
(301) 408-4111 | |
(301) 408-4600 |
Full Name | |
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Speciality | Internal Medicine |
Location | 3331 Toledo Ter Ste 108, Hyattsville, Maryland |
Authorized Official Name and Position | Godswill O Okoji (MEDICAL DIRECTOR) |
Authorized Official Contact | 3014084111 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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3331 Toledo Ter Ste 108 Hyattsville MD 20782-8156 Ph: (301) 408-4111 | 3331 Toledo Ter Ste 108 Hyattsville MD 20782-8156 Ph: (301) 408-4111 |
NPI Number | 1053365221 |
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Provider Enumeration Date | 05/20/2006 |
Last Update Date | 07/22/2020 |
Medicare PECOS PAC ID | 8426079179 |
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Medicare Enrollment ID | O20051209000498 |
Identifier | Type | State | Issuer |
---|---|---|---|
1053365221 | NPI | - | NPPES |
017125200 | Medicaid | DC | |
G00880 | Other | MD | MEDICARE GROUP NUMBER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | D0050545 (Maryland) | Primary |
Provider Name | Godswill O Okoji |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1518980812 PECOS PAC ID: 8123049871 Enrollment ID: I20101229001082 |
Provider Name | Arlette Leonie Poumini |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1376200816 PECOS PAC ID: 2264822501 Enrollment ID: I20211201000940 |
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