Provider Demographics
NPI:1780973305
Name:ECHEBIRI, NELSON C (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:NELSON
Middle Name:C
Last Name:ECHEBIRI
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1100
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-1100
Mailing Address - Country:US
Mailing Address - Phone:240-252-2140
Mailing Address - Fax:240-252-2141
Practice Address - Street 1:26005 RIDGE RD STE 200
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:MD
Practice Address - Zip Code:20872-1899
Practice Address - Country:US
Practice Address - Phone:301-414-2300
Practice Address - Fax:301-414-2306
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101258139207V00000X
OK28572207V00000X
MDD80259207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD871103800Medicaid