Healthcare Provider Details

I. General information

NPI: 1669276051
Provider Name (Legal Business Name): MIRACLE CHINONSO OPARAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 08/06/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 GRANT STREET DEPARTMENT OF MEDICINE, BRIDGEPORT HOSPITAL
BRIDGEPORT CT
06610
US

IV. Provider business mailing address

267 GRANT STREET DEPARTMENT OF MEDICINE, BRIDGEPORT HOSPITAL
BRIDGEPORT CT
06610
US

V. Phone/Fax

Practice location:
  • Phone: 203-384-3792
  • Fax:
Mailing address:
  • Phone: 203-384-3792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: