Active NPI
Polycarp Eburuoh
- Registered Nurse
- Largo, MD
National Provider Identifier
1790213742
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- R194007
- Practice address
- 9500 Medical Center Dr Ste 350
Largo, MD 20774-3715 - Phone
- (301) 655-7114
- Fax
- (240) 525-0892
- NPI assigned
- Jun 2, 2017
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | R194007 | MD | Primary |
Addresses
Primary practice location
9500 Medical Center Dr Ste 350
Largo, MD 20774-3715
Mailing address
11001 Enoch CT
Upper Marlboro, MD 20774-2111
Phone (301) 655-7114
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R194007 | MD | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Millennium Global Healthcare Corporation | Registered Nurse | Current | Accepting new patients |
| Millennium Ventures Corporation | Current | Accepting new patients |
Locations
9500 Medical Center Dr
Ste 350
Upper Marlboro, MD 20774
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Registered Nurse
- Upper Marlboro, MD
- NPI 1639998461
-
- In Home Supportive Care Agency
- Largo, MD
- NPI 1063953818
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1496361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1784764800000",
"number": "1790213742",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11001 ENOCH CT",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207742111",
"telephone_number": "301-655-7114"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9500 MEDICAL CENTER DR STE 350",
"city": "LARGO",
"state": "MD",
"postal_code": "207743715",
"telephone_number": "301-655-7114",
"fax_number": "240-525-0892"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EBURUOH",
"first_name": "POLYCARP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-06-02",
"last_updated": "2026-07-23",
"certification_date": "2026-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MD",
"license": "R194007",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Largo, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.