CAMELLUS O EZEUGWU M.D., NPI 1194720110 — BALTIMORE (MD)

NPI 1194720110

14+ Years Experience Individual

CAMELLUS O EZEUGWU M.D.

06/16/2005
PROVIDER ENUMERATION DATE
12/16/2013
LAST UPDATE DATE
1194720110
NPI NUMBER

About CAMELLUS O EZEUGWU

Sole proprietor? Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor.

CAMELLUS O EZEUGWU is a provider established in BALTIMORE, MD. The NPI number of CAMELLUS O EZEUGWU is 1194720110 and was assigned on 06/16/2005. The practitioners primary taxonomy code is: 174400000X with license number: D0053981 MD .

Mailing address

  • City: ELLICOTT CITY
  • State: MD
  • Postal code: 210425337
  • Phone: 4102258615
  • Fax: 4104625095
  • Address: 3906 SAINT JOHNS LN
  • Address 2: PO BOX 6545

Primary Practice Address

  • Region : BALTIMORE, MD
  • NPI : 1194720110
  • Phone : 4102258615
  • Fax : 4104625095
  • Postalcode : 212014603
  • Address : 300 ARMORY PL STE 3M

Provider taxonomy - Specialist

  • Taxonomy code: 174400000X
  • License number: D0053981
  • License state: MD

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

Contacts:

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  • CAMELLUS O EZEUGWU M.D.
  • Address : 300 ARMORY PL STE 3M
  • Region : BALTIMORE, MD
  • NPI : 1194720110
  • Phone : 4102258615
  • Fax : 4104625095
  • Postalcode : 212014603

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address300 ARMORY PL
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location AddressSTE 3M
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameBALTIMORE
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameMD
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code212014603
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number4102258615
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number4104625095
The fax number associated with the location address of the provider being identified.
NPI1194720110
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1174400000X
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
Provider Enumeration Date06/16/2005
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated12/16/2013
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)CAMELLUS O EZEUGWU
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address3906 SAINT JOHNS LN
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Second Line Business Mailing AddressPO BOX 6545
The second line mailing address of the provider being identified. This data element may contain the same information as "Provider second line location address".
Provider Business Mailing Address City NameELLICOTT CITY
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameMD
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code210425337
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number4102258615
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number4104625095
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Healthcare Provider Taxonomy Code #1174400000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
Provider License Number 1D0053981
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1MD
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Provider Gender CodeM
  • M - male
  • F - female
Is sole proprietorY
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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