Healthcare Provider Details

I. General information

NPI: 1568306579
Provider Name (Legal Business Name): ADAUGO CHIKEZIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2026
Last Update Date: 04/18/2026
Certification Date: 04/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RETREAT AVE
HARTFORD CT
06102-3102
US

IV. Provider business mailing address

1212 MAIN ST APT 638
HARTFORD CT
06103-1278
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-1997
  • Fax:
Mailing address:
  • Phone: 908-907-4873
  • 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 StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: