Healthcare Provider Details

I. General information

NPI: 1255548178
Provider Name (Legal Business Name): CHINWE TOSHA ERIKE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 01/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 TOWN ST
NORWICH CT
06360-2315
US

IV. Provider business mailing address

47 TOWN ST
NORWICH CT
06360-2315
US

V. Phone/Fax

Practice location:
  • Phone: 860-892-7042
  • Fax: 860-823-3060
Mailing address:
  • Phone: 860-892-7042
  • Fax: 860-823-3060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number050245
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number050245
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: