Provider Demographics
NPI:1780138875
Name:IGBO, ADAIBA CHINWE (RD/LDN)
Entity type:Individual
Prefix:MRS
First Name:ADAIBA
Middle Name:CHINWE
Last Name:IGBO
Suffix:
Gender:F
Credentials:RD/LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14205 BENNETT RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2002
Mailing Address - Country:US
Mailing Address - Phone:301-509-3211
Mailing Address - Fax:
Practice Address - Street 1:14205 BENNETT RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2002
Practice Address - Country:US
Practice Address - Phone:301-509-3211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-07
Last Update Date:2016-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD02039133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered