Provider Demographics
NPI:1174954705
Name:ADVANCED NEIGHBORHOOD PEDIATRICS
Entity type:Organization
Organization Name:ADVANCED NEIGHBORHOOD PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ONYINYE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ONYEKWERE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MS, FAAP
Authorized Official - Phone:240-641-8160
Mailing Address - Street 1:12239 CYPRESS SPRING RD
Mailing Address - Street 2:SUITE 010
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-4415
Mailing Address - Country:US
Mailing Address - Phone:240-374-8616
Mailing Address - Fax:240-780-7159
Practice Address - Street 1:8607 2ND AVE STE 505A
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3355
Practice Address - Country:US
Practice Address - Phone:240-641-8160
Practice Address - Fax:240-331-0073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-08
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063251261QP2300X, 261QM2500X
DCMD33750261QP2300X, 261QM2500X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC035348700Medicaid
DC097545400Medicaid
MD403549600Medicaid
MD403549601Medicaid
DC347196OtherMEDICARE