| Ciwo Healthcare Services | |
|
10100 Balsamwood Dr Laurel MD 20708-3152 | |
| (973) 866-7691 | |
| Not Available |
| Full Name | Ciwo Healthcare Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 10100 Balsamwood Dr, Laurel, Maryland |
| Authorized Official Name and Position | Chioma Ejemole (PRESIDENT) |
| Authorized Official Contact | 9738667691 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ciwo Healthcare Services 10100 Balsamwood Dr Laurel MD 20708-3152 Ph: (973) 866-7691 | Ciwo Healthcare Services 10100 Balsamwood Dr Laurel MD 20708-3152 Ph: (973) 866-7691 |
| NPI Number | 1548032238 |
|---|---|
| Provider Enumeration Date | 10/25/2023 |
| Last Update Date | 10/25/2023 |
| Certification Date | 10/25/2023 |
| Medicare PECOS PAC ID | 7012364342 |
|---|---|
| Medicare Enrollment ID | O20231108002396 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548032238 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Primary |
| 363LF0000X | Nurse Practitioner - Family | () | Secondary |
| Provider Name | Chioma Ejemole |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700359163 PECOS PAC ID: 3476954314 Enrollment ID: I20230406002397 |
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