Provider Demographics
NPI:1053997122
Name:EGWUATU, THICKNESS PATRICK
Entity type:Individual
Prefix:
First Name:THICKNESS
Middle Name:PATRICK
Last Name:EGWUATU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10604 WOOD POINTE CT
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-2112
Mailing Address - Country:US
Mailing Address - Phone:202-288-7752
Mailing Address - Fax:
Practice Address - Street 1:10604 WOOD POINTE CT
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-2112
Practice Address - Country:US
Practice Address - Phone:202-288-7752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR172332363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health