Provider Demographics
NPI:1174705149
Name:IHEAGWARA, OYIJE SUSAN (MD)
Entity type:Individual
Prefix:DR
First Name:OYIJE
Middle Name:SUSAN
Last Name:IHEAGWARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OYIJE
Other - Middle Name:SUSAN
Other - Last Name:OGEZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2041 GEORGIA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20060-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2041 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-0001
Practice Address - Country:US
Practice Address - Phone:202-865-6620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD445700207RN0300X, 207R00000X
DCMD038844207RN0300X
MDD0076497207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30122860OtherAMERIHEALTH MERCY - WMG
PA418683OtherUPMC
PA102724100Medicaid
PAP01110056OtherRAILROAD MEDICARE
PA2718719OtherHIGHMARK BLUE SHIELD
PA242546FLTMedicare PIN