Healthcare Provider Details

I. General information

NPI: 1952116394
Provider Name (Legal Business Name): MR. TOCHUKWU ANSELM DIKE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TOCHUKWU ANSELM DIKE RN

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1949 4TH ST NE
WASHINGTON DC
20002-1211
US

IV. Provider business mailing address

149 R ST NE APT 1
WASHINGTON DC
20002-2150
US

V. Phone/Fax

Practice location:
  • Phone: 202-462-7500
  • Fax:
Mailing address:
  • Phone: 310-720-0616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN500006379
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: