Active NPI
Endurance Egonmwan
- Occupational Therapist
- Baltimore, MD
National Provider Identifier
1154724714
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 11112
- Practice address
- 416 E 30TH St
Baltimore, MD 21218-3934 - Phone
- (410) 889-0727
- Fax
- (410) 889-0729
- NPI assigned
- Sep 26, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 11112 | MA | Primary |
Addresses
Primary practice location
416 E 30TH St
Baltimore, MD 21218-3934
Mailing address
416 E 30TH St
Baltimore, MD 21218-3934
Phone (410) 889-0727
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1411689600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1411689600000",
"number": "1154724714",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "416 E 30TH ST",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212183934",
"telephone_number": "410-889-0727",
"fax_number": "410-889-0729"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "416 E 30TH ST",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212183934",
"telephone_number": "410-889-0727",
"fax_number": "410-889-0729"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EGONMWAN",
"first_name": "ENDURANCE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-09-26",
"last_updated": "2014-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MA",
"license": "11112",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.