Prince Georges ENT Head & Neck Surgery, LLC

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

Legal business name

PRINCE GEORGES ENT HEAD & NECK SURGERY, LLC

Practice address

10 Saint Patricks Dr
Waldorf, MD 20603-4527

Phone

(301) 373-7900

Fax

(301) 373-6900

NPI assigned

Aug 22, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Bryan Chinaemerem Ego-Osuala, MD

Title

President

Phone

(202) 999-8413

Specialties & licenses 1

Addresses

Other names 1

• Prince Georges ENT Head & Neck Surgery Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1566432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604620800000",
    "number": "1992352033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 MERCANTILE LN STE 136",
            "city": "UPPR MARLBORO",
            "state": "MD",
            "postal_code": "207745367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 SAINT PATRICKS DR",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034527",
            "telephone_number": "301-373-7900",
            "fax_number": "301-373-6900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRINCE GEORGES ENT HEAD & NECK SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-22",
        "last_updated": "2020-11-06",
        "certification_date": "2020-11-06",
        "status": "A",
        "authorized_official_last_name": "EGO-OSUALA",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "CHINAEMEREM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "202-999-8413",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prince Georges ENT Head & Neck Surgery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Prince Georges ENT Head & Neck Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Otolaryngology Physician in Waldorf, MD
• Providers in Waldorf, MD by specialty
• Otolaryngology Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.