MEDICARE: BRIAN ADIMOLISA CHIGBUE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	D50457	MD

General Provider Information

NPI Number	:	1669497442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN ADIMOLISA CHIGBUE MD

Provider Business Mailing Address
First Line	:	7943 CENTRAL AVE
Second Line	:
City	:	CAPITOL HEIGHTS
State	:	MD
Zip	:	20743
Country	:	US
Telephone Number	:	301-324-0724
Fax Number	:	301-324-0725

Provider Business Practice Location Address
First Line	:	7943 CENTRAL AVE
Second Line	:
City	:	CAPITOL HEIGHTS
State	:	MD
Zip	:	20743
Country	:	US
Telephone Number	:	301-324-0724
Fax Number	:	301-324-0725

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	07/08/2007

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