Active NPI
Peter Methodius-Ngwodo, MD, PA
- Physician Assistant
- Upper Marlboro, MD
National Provider Identifier
1710723416
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 2059
- Practice address
- 2508 Buckingham Green LN Ste B
Upper Marlboro, MD 20774-8020 - Phone
- (301) 728-7827
- NPI assigned
- Jul 2, 2024
- Last updated
- Jul 2, 2024
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2059 | PR | Primary |
Addresses
Primary practice location
2508 Buckingham Green LN Ste B
Upper Marlboro, MD 20774-8020
Mailing address
2508 Buckingham Green LN Ste B
Upper Marlboro, MD 20774-8020
Phone (301) 728-7827
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
- Credentials
- Doctor of Medicine, Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2059 | PR | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1719878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719878400000",
"number": "1710723416",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2508 BUCKINGHAM GREEN LN STE B",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207748020",
"telephone_number": "301-728-7827"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2508 BUCKINGHAM GREEN LN STE B",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207748020",
"telephone_number": "301-728-7827"
}
],
"practiceLocations": [],
"basic": {
"last_name": "METHODIUS-NGWODO",
"first_name": "PETER",
"name_prefix": "Dr.",
"credential": "MD, PA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-07-02",
"last_updated": "2024-07-02",
"certification_date": "2024-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "PR",
"license": "2059",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Upper Marlboro, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.