Provider Demographics
NPI:1053365221
Name:ULNACS MEDICAL CARE, PC
Entity type:Organization
Organization Name:ULNACS MEDICAL CARE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GODSWILL
Authorized Official - Middle Name:O
Authorized Official - Last Name:OKOJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-408-4111
Mailing Address - Street 1:3331 TOLEDO TER STE 108
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-8156
Mailing Address - Country:US
Mailing Address - Phone:301-408-4111
Mailing Address - Fax:301-408-4600
Practice Address - Street 1:3331 TOLEDO TER STE 108
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-8156
Practice Address - Country:US
Practice Address - Phone:301-408-4111
Practice Address - Fax:301-408-4600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050545207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC017125200Medicaid
MDG00880OtherMEDICARE GROUP NUMBER