Provider Demographics
NPI:1548449275
Name:NNAEMEKA AGAJELU MD LLC
Entity type:Organization
Organization Name:NNAEMEKA AGAJELU MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NNAEMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGAJELU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-418-3553
Mailing Address - Street 1:85 KINDRED WAY APT 101
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5246
Mailing Address - Country:US
Mailing Address - Phone:443-418-3553
Mailing Address - Fax:410-553-6661
Practice Address - Street 1:85 KINDRED WAY APT 101
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5246
Practice Address - Country:US
Practice Address - Phone:410-553-6360
Practice Address - Fax:410-553-6661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD56950207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD42217110Medicaid