Provider Demographics
NPI:1710723416
Name:METHODIUS-NGWODO, PETER (MD, PA)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:METHODIUS-NGWODO
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 BUCKINGHAM GREEN LN STE B
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8020
Mailing Address - Country:US
Mailing Address - Phone:301-728-7827
Mailing Address - Fax:
Practice Address - Street 1:2508 BUCKINGHAM GREEN LN STE B
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-8020
Practice Address - Country:US
Practice Address - Phone:301-728-7827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2059363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant